Provider Demographics
NPI:1649096488
Name:LIGHTHOUSE HOME CARE LLC
Entity type:Organization
Organization Name:LIGHTHOUSE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-718-0535
Mailing Address - Street 1:455 SAM BARR DR STE 104
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-9104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 SAM BARR DR STE 104
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-9104
Practice Address - Country:US
Practice Address - Phone:816-718-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care