Provider Demographics
NPI:1659681864
Name:LIGHTHOUSE MERRIMACK, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE MERRIMACK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-745-8505
Mailing Address - Street 1:121 LORING AVE
Mailing Address - Street 2:SUITE 820
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4461
Mailing Address - Country:US
Mailing Address - Phone:978-745-8505
Mailing Address - Fax:978-745-8503
Practice Address - Street 1:121 LORING AVE
Practice Address - Street 2:SUITE 820
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4461
Practice Address - Country:US
Practice Address - Phone:978-745-8505
Practice Address - Fax:978-745-8503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE SENIOR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care