Provider Demographics
NPI:1487891032
Name:LIGHTHOUSE HOME SERVICES
Entity type:Organization
Organization Name:LIGHTHOUSE HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:212-226-2100
Mailing Address - Street 1:121A NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4025
Mailing Address - Country:US
Mailing Address - Phone:718-389-3304
Mailing Address - Fax:718-609-1674
Practice Address - Street 1:121A NASSAU AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4025
Practice Address - Country:US
Practice Address - Phone:718-389-3304
Practice Address - Fax:718-609-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health