Provider Demographics
NPI:1790478360
Name:LIGHTHOUSE GUIDECARE SERVICES LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE GUIDECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GABORKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-280-0730
Mailing Address - Street 1:3801 BRENDAN LN APT 8
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2236
Mailing Address - Country:US
Mailing Address - Phone:216-280-0730
Mailing Address - Fax:
Practice Address - Street 1:3801 BRENDAN LN APT 8
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2236
Practice Address - Country:US
Practice Address - Phone:216-280-0730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty