Your Light Residential Care LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

YOUR LIGHT RESIDENTIAL CARE LLC

Practice address

2640 Albion Ave
Orlando, FL 32833-4342

Phone

(330) 704-5903

NPI assigned

Jun 17, 2020

Last updated

Jun 17, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shardae ComptonNPI 1851615645

Title

Owner

Phone

(330) 415-2708

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shardae' Nicole Compton

  • Licensed Practical Nurse
  • Canton, OH
  • NPI 1851615645
  NPD Authorized official

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1912523879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20926 NETTLETON ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328334362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 ALBION AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328334342",
            "telephone_number": "330-704-5903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20926 Nettleton St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328334362",
            "country_code": "US",
            "telephone_number": "330-415-2708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "YOUR LIGHT RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-17",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "COMPTON",
        "authorized_official_first_name": "SHARDAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-415-2708"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Orlando, FL
• Providers in Orlando, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; 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.