Provider Demographics
NPI:1376949297
Name:LIGHTHOUSE PROFESSIONAL STAFFING, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE PROFESSIONAL STAFFING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MYRTIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-782-1008
Mailing Address - Street 1:4500 FORT JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1119
Mailing Address - Country:US
Mailing Address - Phone:803-782-1008
Mailing Address - Fax:
Practice Address - Street 1:4500 FORT JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1119
Practice Address - Country:US
Practice Address - Phone:803-782-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE STAFFING/CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1000OtherPERSONAL CARE PROVIDERS