Provider Demographics
NPI:1013557040
Name:LIGHTHOUSE ELDER CARE, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE ELDER CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-839-0441
Mailing Address - Street 1:502 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1334
Mailing Address - Country:US
Mailing Address - Phone:207-839-0441
Mailing Address - Fax:207-839-6666
Practice Address - Street 1:502 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1334
Practice Address - Country:US
Practice Address - Phone:207-839-0441
Practice Address - Fax:207-839-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care