Provider Demographics
NPI:1881001576
Name:LIGHTHORSE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:LIGHTHORSE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPC, CPCS, NCC
Authorized Official - Phone:912-882-3800
Mailing Address - Street 1:PO BOX 5250
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-5250
Mailing Address - Country:US
Mailing Address - Phone:912-882-3800
Mailing Address - Fax:
Practice Address - Street 1:2060 DAN PROCTOR DR
Practice Address - Street 2:SUITE 3300
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3894
Practice Address - Country:US
Practice Address - Phone:912-882-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174899454OtherNPI NUMBER