Provider Demographics
NPI:1770789232
Name:SHEPHERDS LIGHTHOUSE, INC.
Entity type:Organization
Organization Name:SHEPHERDS LIGHTHOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-347-6575
Mailing Address - Street 1:5930 SE ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3310
Mailing Address - Country:US
Mailing Address - Phone:352-347-6575
Mailing Address - Fax:352-347-1775
Practice Address - Street 1:5930 SE ROBINSON RD
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3310
Practice Address - Country:US
Practice Address - Phone:352-347-6575
Practice Address - Fax:352-347-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty