Provider Demographics
NPI:1922332360
Name:LIGHTHOUSE SCHOOL, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE SCHOOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-251-4050
Mailing Address - Street 1:25 WELLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1334
Mailing Address - Country:US
Mailing Address - Phone:978-251-4050
Mailing Address - Fax:978-513-2022
Practice Address - Street 1:25 WELLMAN AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1334
Practice Address - Country:US
Practice Address - Phone:978-251-4050
Practice Address - Fax:978-513-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)