Provider Demographics
NPI:1295890291
Name:LIGHTHOUSE FAMILY INJURY CARE
Entity type:Organization
Organization Name:LIGHTHOUSE FAMILY INJURY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:FERNANDES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:954-943-6348
Mailing Address - Street 1:PO BOX 5068
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33074-5068
Mailing Address - Country:US
Mailing Address - Phone:954-943-6348
Mailing Address - Fax:954-943-0228
Practice Address - Street 1:760 W SAMPLE RD
Practice Address - Street 2:SUITE #9
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2768
Practice Address - Country:US
Practice Address - Phone:954-943-6348
Practice Address - Fax:954-943-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4989261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation