Provider Demographics
NPI:1407657737
Name:LIGHTHOUSE COMMUNITY TRANSPORT, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE COMMUNITY TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN CCM
Authorized Official - Phone:631-599-2022
Mailing Address - Street 1:99 S BICYCLE PATH
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3823
Mailing Address - Country:US
Mailing Address - Phone:631-599-6202
Mailing Address - Fax:631-599-6202
Practice Address - Street 1:99 S BICYCLE PATH
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3823
Practice Address - Country:US
Practice Address - Phone:631-599-6202
Practice Address - Fax:631-599-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)