Provider Demographics
NPI:1972929347
Name:LIGHTHOUSE HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:SEBRING
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:813-442-5492
Mailing Address - Street 1:509 GUISANDO DE AVILA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-5235
Mailing Address - Country:US
Mailing Address - Phone:813-442-5492
Mailing Address - Fax:
Practice Address - Street 1:3720 W BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6912
Practice Address - Country:US
Practice Address - Phone:813-442-5492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9298310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility