Provider Demographics
NPI:1871822197
Name:THE LIGHT HOUSE OF LOVE
Entity Type:Organization
Organization Name:THE LIGHT HOUSE OF LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WRIGHT TAPPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-633-7923
Mailing Address - Street 1:730 W CHEYENNE AVE STE 40
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7849
Mailing Address - Country:US
Mailing Address - Phone:702-633-7923
Mailing Address - Fax:702-633-7610
Practice Address - Street 1:730 W CHEYENNE AVE STE 40
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7849
Practice Address - Country:US
Practice Address - Phone:702-633-7923
Practice Address - Fax:702-633-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty