Provider Demographics
NPI:1396069068
Name:LIGHTHOUSE CAREGIVERS
Entity type:Organization
Organization Name:LIGHTHOUSE CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERTRUDE JOY
Authorized Official - Middle Name:LARDIZABAL
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-604-6944
Mailing Address - Street 1:88 N HILL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-1200
Mailing Address - Country:US
Mailing Address - Phone:800-604-6944
Mailing Address - Fax:888-767-7044
Practice Address - Street 1:88 N HILL DR
Practice Address - Street 2:SUITE C
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005-1200
Practice Address - Country:US
Practice Address - Phone:800-604-6944
Practice Address - Fax:888-767-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care