Provider Demographics
NPI:1033248141
Name:LIGHTHOUSE CENTRAL FLORIDA INC
Entity Type:Organization
Organization Name:LIGHTHOUSE CENTRAL FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NASEHI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:407-898-2483
Mailing Address - Street 1:215 E NEW HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6403
Mailing Address - Country:US
Mailing Address - Phone:407-898-2483
Mailing Address - Fax:407-895-5255
Practice Address - Street 1:215 E NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6403
Practice Address - Country:US
Practice Address - Phone:407-898-2483
Practice Address - Fax:407-895-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB690Medicare PIN
FLDG2334Medicare PIN