Provider Demographics
NPI:1437321395
Name:LIGHTHOUSE MINISTRIES PROVDIER CARE SERVICE, INC,
Entity Type:Organization
Organization Name:LIGHTHOUSE MINISTRIES PROVDIER CARE SERVICE, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:WATKINS
Authorized Official - Last Name:BEANER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-688-4260
Mailing Address - Street 1:7505 PINES RD
Mailing Address - Street 2:SUITE #1170
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3935
Mailing Address - Country:US
Mailing Address - Phone:318-688-4260
Mailing Address - Fax:318-688-4261
Practice Address - Street 1:7505 PINES RD
Practice Address - Street 2:SUITE #1170
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3935
Practice Address - Country:US
Practice Address - Phone:318-688-4260
Practice Address - Fax:318-688-4261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHURCH IN JESUS CHRIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46701251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care