Provider Demographics
NPI:1972983104
Name:LITTLE LANTERN CARE LLC
Entity Type:Organization
Organization Name:LITTLE LANTERN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-358-0435
Mailing Address - Street 1:2705 DAMSEL BELLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6169
Mailing Address - Country:US
Mailing Address - Phone:979-358-0435
Mailing Address - Fax:
Practice Address - Street 1:2705 DAMSEL BELLA BLVD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-6169
Practice Address - Country:US
Practice Address - Phone:979-358-0435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7387208600000X, 208D00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty