NPIMap

Organization Active NPI

House of Light Senior Living, LLC

  • Assisted Living Facility
  • Palm Bay, FL
National Provider Identifier
1053735514
Registry record updated Nov 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
HOUSE OF LIGHT SENIOR LIVING, LLC
Doing business as
House of Light Senior Living II
Practice address
1797 Blaine St NE
Palm Bay, FL 32905-5142
Phone
(321) 914-3658
Fax
(321) 345-5925
NPI assigned
Feb 4, 2014
Organization subpart
Yes
Parent organization
HOUSE OF LIGHT SENIOR LIVING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Viviene Cornetta Moore
Title
Administrator
Phone
(321) 806-7091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X FL Primary

Addresses

Primary practice location

1797 Blaine St NE
Palm Bay, FL 32905-5142

Mailing address

1797 Blaine St NE
Palm Bay, FL 32905-5142
Phone (321) 914-3658

Other names 1

  • House of Light Senior Living II Doing business as

National Provider Directory

National Provider Directory
Tax ID family
House of Light Senior Living LLC3 organizations share this tax ID, including this one
Part of
House of Light Senior Living LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1053735514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1797 BLAINE ST NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055142",
            "telephone_number": "321-914-3658",
            "fax_number": "321-345-5925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1797 BLAINE ST NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055142",
            "telephone_number": "321-914-3658",
            "fax_number": "321-345-5925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSE OF LIGHT SENIOR LIVING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOUSE OF LIGHT SENIOR LIVING, LLC",
        "enumeration_date": "2014-02-04",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "VIVIENE",
        "authorized_official_middle_name": "CORNETTA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-806-7091",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "House of Light Senior Living II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.