Provider Demographics
NPI:1932868072
Name:LIGHTHOUSE SOCIAL SERVICE CENTERS
Entity Type:Organization
Organization Name:LIGHTHOUSE SOCIAL SERVICE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG-LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-571-3533
Mailing Address - Street 1:1003 E COOLEY DR STE 205
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3907
Mailing Address - Country:US
Mailing Address - Phone:909-571-3533
Mailing Address - Fax:
Practice Address - Street 1:1003 E COOLEY DR STE 205
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3907
Practice Address - Country:US
Practice Address - Phone:909-571-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management