Provider Demographics
NPI:1851666200
Name:LIGHTHOUSE PRIMARY HOME CARE LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE PRIMARY HOME CARE LLC
Other - Org Name:LIGHTHOUSE PRIMARY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NATIVIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-444-1825
Mailing Address - Street 1:1716 S SAN MARCOS
Mailing Address - Street 2:SUITE 27
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-7094
Mailing Address - Country:US
Mailing Address - Phone:210-444-1825
Mailing Address - Fax:210-223-9128
Practice Address - Street 1:1716 S SAN MARCOS
Practice Address - Street 2:SUITE 27
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-7094
Practice Address - Country:US
Practice Address - Phone:210-444-1825
Practice Address - Fax:210-223-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care