Organization
LIGHT HOUSE DAY SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACEY CORIOLAN (OWNER)
(804) 301-2928
Entity
Organization
Contact information
Practice address
2030 CADILLAC TRL, NORTH CHESTERFIELD, VA 23236-1818
(804) 301-2928
Mailing address
2030 CADILLAC TRL, NORTH CHESTERFIELD, VA 23236-1818
(804) 301-2928
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
04/09/2026
Last updated
04/09/2026
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