Provider Demographics
NPI:1184226722
Name:THE CHILDREN'S LIGHTHOUSE FOUNDATION
Entity Type:Organization
Organization Name:THE CHILDREN'S LIGHTHOUSE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-888-1444
Mailing Address - Street 1:24600 MANISTEE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1712
Mailing Address - Country:US
Mailing Address - Phone:313-888-1444
Mailing Address - Fax:
Practice Address - Street 1:8720 PURITAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1114
Practice Address - Country:US
Practice Address - Phone:313-888-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health