Provider Demographics
NPI:1467592162
Name:OPERATION LIGHTHOUSE, INC
Entity Type:Organization
Organization Name:OPERATION LIGHTHOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-670-9577
Mailing Address - Street 1:125 SAYLES BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-2001
Mailing Address - Country:US
Mailing Address - Phone:325-670-9577
Mailing Address - Fax:325-670-6040
Practice Address - Street 1:125 SAYLES BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-2001
Practice Address - Country:US
Practice Address - Phone:325-670-9577
Practice Address - Fax:325-670-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101717OtherDADS FACILITY ID
TX114356OtherTEXAS DADS LICENSE