Provider Demographics
NPI:1073822318
Name:LIGHTHOUSE LIVING SERVICES, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE LIVING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TABIAS
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-454-4381
Mailing Address - Street 1:3600 POWER INN RD
Mailing Address - Street 2:SUITE H1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3826
Mailing Address - Country:US
Mailing Address - Phone:916-454-4381
Mailing Address - Fax:916-454-1497
Practice Address - Street 1:3600 POWER INN RD
Practice Address - Street 2:SUITE H1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3826
Practice Address - Country:US
Practice Address - Phone:916-454-4381
Practice Address - Fax:916-454-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care