Provider Demographics
NPI:1063480846
Name:LIGHTHOUSE YOUTH SERVICES INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE YOUTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARILON
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-221-3350
Mailing Address - Street 1:1501 MADISON RD
Mailing Address - Street 2:2ND, FLOOR
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1776
Mailing Address - Country:US
Mailing Address - Phone:513-221-3350
Mailing Address - Fax:513-221-3665
Practice Address - Street 1:131 N LUDLOW ST
Practice Address - Street 2:SUITE 384
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1116
Practice Address - Country:US
Practice Address - Phone:937-586-0435
Practice Address - Fax:937-586-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0259101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11166Medicaid