Provider Demographics
NPI:1295298123
Name:LIGHTHOUSE TRANSIT LLC
Entity type:Organization
Organization Name:LIGHTHOUSE TRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:C N
Authorized Official - Last Name:AMANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-228-3023
Mailing Address - Street 1:1605 CLIFF RD E APT 216
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1335
Mailing Address - Country:US
Mailing Address - Phone:763-228-3023
Mailing Address - Fax:
Practice Address - Street 1:1010 LAFOND AVE APT 4
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2115
Practice Address - Country:US
Practice Address - Phone:612-564-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1079441100020OtherNON EMERGENCY MEDICAL TRANSPORTATION