Provider Demographics
NPI:1205044328
Name:GARRETT COUNTY LIGHTHOUSE, INC.
Entity Type:Organization
Organization Name:GARRETT COUNTY LIGHTHOUSE, INC.
Other - Org Name:COMPASS HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-334-9126
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-0116
Mailing Address - Country:US
Mailing Address - Phone:301-334-9126
Mailing Address - Fax:301-334-8894
Practice Address - Street 1:418 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3759
Practice Address - Country:US
Practice Address - Phone:240-362-7082
Practice Address - Fax:240-362-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401278000Medicaid