Provider Demographics
NPI:1215086871
Name:MY LIGHTHOUSE OF HOPE, INC.
Entity type:Organization
Organization Name:MY LIGHTHOUSE OF HOPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHLHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-968-8502
Mailing Address - Street 1:768 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-1636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:979-968-5210
Practice Address - Street 1:768 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1636
Practice Address - Country:US
Practice Address - Phone:979-968-8502
Practice Address - Fax:979-968-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities