Provider Demographics
NPI:1821568874
Name:LIGHTHOUSE HOME CARE 1, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE HOME CARE 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ANABELLA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-522-2509
Mailing Address - Street 1:1154 OCEANVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3905
Mailing Address - Country:US
Mailing Address - Phone:907-440-1160
Mailing Address - Fax:907-522-2509
Practice Address - Street 1:1154 OCEANVIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3905
Practice Address - Country:US
Practice Address - Phone:907-522-2509
Practice Address - Fax:907-522-2509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOSUE HOME CARE 1, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility