Provider Demographics
NPI:1619181153
Name:LIGHTHOUSE ACADEMIES OF INDIANA, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE ACADEMIES OF INDIANA, INC.
Other - Org Name:WEST GARY LIGHTHOUSE CHARTER SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-626-0901
Mailing Address - Street 1:1661 WORCESTER RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5402
Mailing Address - Country:US
Mailing Address - Phone:508-626-0901
Mailing Address - Fax:508-626-0905
Practice Address - Street 1:725 CLARK RD
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46406-1822
Practice Address - Country:US
Practice Address - Phone:219-977-9583
Practice Address - Fax:219-977-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)