Provider Demographics
NPI:1972852838
Name:LIGHTHOUSE HOMECARE
Entity Type:Organization
Organization Name:LIGHTHOUSE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-985-3142
Mailing Address - Street 1:10514 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2959
Mailing Address - Country:US
Mailing Address - Phone:214-469-9103
Mailing Address - Fax:
Practice Address - Street 1:10514 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2959
Practice Address - Country:US
Practice Address - Phone:214-469-9103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health