Provider Demographics
NPI:1649767500
Name:LIGHTHOUSE COMPANION CARE, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE COMPANION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RACCIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-395-2990
Mailing Address - Street 1:129 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2377
Mailing Address - Country:US
Mailing Address - Phone:860-395-2990
Mailing Address - Fax:860-388-4300
Practice Address - Street 1:129 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2377
Practice Address - Country:US
Practice Address - Phone:860-395-2990
Practice Address - Fax:860-388-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty