Provider Demographics
NPI:1932336187
Name:LIGHTHOUSE OF BROWARD COUNTY, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE OF BROWARD COUNTY, INC.
Other - Org Name:LIGHTHOUSE OF BROWARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DU PRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPA
Authorized Official - Phone:954-463-4217
Mailing Address - Street 1:650 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-7436
Mailing Address - Country:US
Mailing Address - Phone:954-463-4217
Mailing Address - Fax:954-764-3825
Practice Address - Street 1:650 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7436
Practice Address - Country:US
Practice Address - Phone:954-463-4217
Practice Address - Fax:954-764-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care