Provider Demographics
NPI:1457484875
Name:LIGHTHOUSE FOR YOUTH
Entity Type:Organization
Organization Name:LIGHTHOUSE FOR YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'KULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-782-8940
Mailing Address - Street 1:81 SPENCER CT
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2820
Mailing Address - Country:US
Mailing Address - Phone:401-782-8940
Mailing Address - Fax:401-782-1145
Practice Address - Street 1:81 SPENCER CT
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2820
Practice Address - Country:US
Practice Address - Phone:401-782-8940
Practice Address - Fax:401-782-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children