Provider Demographics
NPI:1770661092
Name:LIGHTHOUSE, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-673-2500
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:1655 E CARO RD
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-0289
Mailing Address - Country:US
Mailing Address - Phone:989-673-2500
Mailing Address - Fax:989-673-3356
Practice Address - Street 1:1655 E CARO RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9319
Practice Address - Country:US
Practice Address - Phone:989-673-2500
Practice Address - Fax:989-673-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0990686OtherHEALTH PLUS
MI30744OtherBLUE CROSS PROVIDER NUMBE
MI30744OtherBLUE CROSS PROVIDER NUMBE
MI236771Medicare ID - Type UnspecifiedMEDICARE