Provider Demographics
NPI:1568287225
Name:LIGHTHOUSE OF HOPE, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE OF HOPE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-890-2199
Mailing Address - Street 1:1301 WILDCAT LN
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-7823
Mailing Address - Country:US
Mailing Address - Phone:352-631-3912
Mailing Address - Fax:407-477-6541
Practice Address - Street 1:1301 WILDCAT LN
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-7823
Practice Address - Country:US
Practice Address - Phone:352-631-3912
Practice Address - Fax:407-477-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021753700Medicaid