Provider Demographics
NPI:1225647696
Name:LIGHTHOUSE COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-504-1663
Mailing Address - Street 1:PO BOX 199
Mailing Address - Street 2:
Mailing Address - City:BOWDOINHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04008-0199
Mailing Address - Country:US
Mailing Address - Phone:207-504-1663
Mailing Address - Fax:
Practice Address - Street 1:9 FELDSPAR LN
Practice Address - Street 2:
Practice Address - City:BOWDOINHAM
Practice Address - State:ME
Practice Address - Zip Code:04008-4252
Practice Address - Country:US
Practice Address - Phone:207-504-1663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management