Provider Demographics
NPI:1225466709
Name:THE LIGHTHOUSE LLC
Entity Type:Organization
Organization Name:THE LIGHTHOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLANGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEEVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-884-4049
Mailing Address - Street 1:5710 E TROPICANA AVE #2212
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NEVADA
Mailing Address - Zip Code:89122
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5710 E TROPICANA AVE #2212
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NEVADA
Practice Address - Zip Code:89122
Practice Address - Country:UM
Practice Address - Phone:702-884-4049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131588522251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1144580846Medicaid
NV1215372115Medicaid
NV1255607719Medicaid
NV1497008031Medicaid
NV1326318601Medicaid