Provider Demographics
NPI:1316665227
Name:LIGHTHOUSE SUPPORT SERVICES INC.
Entity type:Organization
Organization Name:LIGHTHOUSE SUPPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUCDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-987-4345
Mailing Address - Street 1:3055 OLD HIGHWAY 8 STE 107
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2500
Mailing Address - Country:US
Mailing Address - Phone:612-987-4345
Mailing Address - Fax:
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 107
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2500
Practice Address - Country:US
Practice Address - Phone:612-987-4345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care