Provider Demographics
NPI:1699209460
Name:LIGHTHOUSE CONCIERGE LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE CONCIERGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAYMUS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MCTEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-857-2567
Mailing Address - Street 1:505 PLEASANT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1236
Mailing Address - Country:US
Mailing Address - Phone:860-857-2567
Mailing Address - Fax:
Practice Address - Street 1:505 PLEASANT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1236
Practice Address - Country:US
Practice Address - Phone:860-857-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1805343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)