Provider Demographics
NPI:1740435676
Name:LIGHTHOUSE FOR THE BLIND
Entity type:Organization
Organization Name:LIGHTHOUSE FOR THE BLIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EMPLOYMENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:DELAUNE
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-899-4507
Mailing Address - Street 1:123 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5733
Mailing Address - Country:US
Mailing Address - Phone:504-899-4501
Mailing Address - Fax:504-895-4162
Practice Address - Street 1:123 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5733
Practice Address - Country:US
Practice Address - Phone:504-899-4501
Practice Address - Fax:504-895-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305R00000X, 305S00000X
LA305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service