Provider Demographics
NPI:1770843997
Name:LIGHTHOUSE RANCH FOR BOYS INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE RANCH FOR BOYS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-878-6560
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-0238
Mailing Address - Country:US
Mailing Address - Phone:985-878-6560
Mailing Address - Fax:985-878-9370
Practice Address - Street 1:51453 HWY 443
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446
Practice Address - Country:US
Practice Address - Phone:985-878-6560
Practice Address - Fax:985-878-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15250320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness