Provider Demographics
NPI:1477096220
Name:LIGHTHOUSE HOSPICE LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-546-0023
Mailing Address - Street 1:3061 S MERIDIAN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7962
Mailing Address - Country:US
Mailing Address - Phone:208-546-0023
Mailing Address - Fax:208-947-3465
Practice Address - Street 1:3061 S MERIDIAN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7962
Practice Address - Country:US
Practice Address - Phone:208-546-0023
Practice Address - Fax:208-947-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based