Provider Demographics
NPI:1205516234
Name:LIGHTHOUSE FAMILY SERVICES LLC
Entity type:Organization
Organization Name:LIGHTHOUSE FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KECHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-801-8050
Mailing Address - Street 1:97 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-2945
Mailing Address - Country:US
Mailing Address - Phone:718-801-8050
Mailing Address - Fax:
Practice Address - Street 1:97 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-2945
Practice Address - Country:US
Practice Address - Phone:718-801-8050
Practice Address - Fax:718-801-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty