Provider Demographics
NPI:1598361941
Name:GARRETT COUNTY LIGHTHOUSE, INC.
Entity Type:Organization
Organization Name:GARRETT COUNTY LIGHTHOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-334-9126
Mailing Address - Street 1:20 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1802
Mailing Address - Country:US
Mailing Address - Phone:301-334-9126
Mailing Address - Fax:
Practice Address - Street 1:18 E. OAK STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-334-1642
Practice Address - Fax:301-334-8894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARRETT COUNTY LIGHTHOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health