Provider Demographics
NPI:1508118118
Name:LIGHTHOUSE HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-538-3605
Mailing Address - Street 1:1060 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5922
Mailing Address - Country:US
Mailing Address - Phone:772-226-7930
Mailing Address - Fax:772-226-7931
Practice Address - Street 1:1060 6TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5922
Practice Address - Country:US
Practice Address - Phone:772-538-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health