Provider Demographics
NPI:1124580071
Name:LIGHTHOUSE ASSISTED LIVING, INC.
Entity type:Organization
Organization Name:LIGHTHOUSE ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-344-7217
Mailing Address - Street 1:6415 MONTANO PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8139
Mailing Address - Country:US
Mailing Address - Phone:720-344-7217
Mailing Address - Fax:720-200-4906
Practice Address - Street 1:6318 S EMPORIA CIR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5528
Practice Address - Country:US
Practice Address - Phone:720-344-7217
Practice Address - Fax:720-200-4906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000143424Medicaid