Provider Demographics
NPI:1477067072
Name:LAMPLIGHT FM PLC LLC
Entity Type:Organization
Organization Name:LAMPLIGHT FM PLC LLC
Other - Org Name:LAMPLIGHT OF FORT MYERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PETRAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:260-797-9482
Mailing Address - Street 1:3630 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2062
Mailing Address - Country:US
Mailing Address - Phone:260-797-9482
Mailing Address - Fax:
Practice Address - Street 1:1896 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3738
Practice Address - Country:US
Practice Address - Phone:239-939-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility