Provider Demographics
NPI:1346970829
Name:LIGHTHOUSE INC
Entity Type:Organization
Organization Name:LIGHTHOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-739-6811
Mailing Address - Street 1:11300 SAINT CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2721
Mailing Address - Country:US
Mailing Address - Phone:314-739-6811
Mailing Address - Fax:
Practice Address - Street 1:3212 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1323
Practice Address - Country:US
Practice Address - Phone:816-361-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children