Provider Demographics
NPI:1194528950
Name:LIGHTHOUSE RESIDENTIAL CARE HOME LLC.
Entity type:Organization
Organization Name:LIGHTHOUSE RESIDENTIAL CARE HOME LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-207-8397
Mailing Address - Street 1:165 LENOX CT
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-4563
Mailing Address - Country:US
Mailing Address - Phone:678-207-8397
Mailing Address - Fax:
Practice Address - Street 1:165 LENOX CT
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-4563
Practice Address - Country:US
Practice Address - Phone:678-207-8397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care