Provider Demographics
NPI:1558969105
Name:LIGHTHOUSE CLOVER LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE CLOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MSM LNHA
Authorized Official - Phone:516-680-7687
Mailing Address - Street 1:180 HARBORVIEW N
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1904
Mailing Address - Country:US
Mailing Address - Phone:516-680-7687
Mailing Address - Fax:
Practice Address - Street 1:28 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NJ
Practice Address - Zip Code:07832-2324
Practice Address - Country:US
Practice Address - Phone:908-496-4307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility