Provider Demographics
NPI:1689062937
Name:THE LIGHTHOUSE OF LOVE
Entity Type:Organization
Organization Name:THE LIGHTHOUSE OF LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TAPPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-630-2407
Mailing Address - Street 1:896 S VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4412
Mailing Address - Country:US
Mailing Address - Phone:702-258-0031
Mailing Address - Fax:702-258-0051
Practice Address - Street 1:896 S.VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107
Practice Address - Country:US
Practice Address - Phone:702-258-0031
Practice Address - Fax:702-258-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1144630658Medicaid
NV1760718522Medicaid
NV1104132828Medicaid
NV1396174785Medicaid
NV1619284692Medicaid
NV1700193976Medicaid
NV1871822197Medicaid
NM1962719625Medicaid
NV1083022586Medicaid
NV1376879155Medicaid