Provider Demographics
NPI:1093444861
Name:LIGHTHOUSE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGISHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-344-7675
Mailing Address - Street 1:22 SARGEANT ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3461
Mailing Address - Country:US
Mailing Address - Phone:120-734-4767
Mailing Address - Fax:
Practice Address - Street 1:22 SARGEANT ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3461
Practice Address - Country:US
Practice Address - Phone:120-734-4767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities