Provider Demographics
NPI:1235354770
Name:LIGHTHOUSE GUESTHOUSE, INC
Entity Type:Organization
Organization Name:LIGHTHOUSE GUESTHOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-742-3336
Mailing Address - Street 1:1480 230TH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-8607
Mailing Address - Country:US
Mailing Address - Phone:785-742-3336
Mailing Address - Fax:
Practice Address - Street 1:1480 230TH ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-8607
Practice Address - Country:US
Practice Address - Phone:785-742-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB007002310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility