Provider Demographics
NPI:1952188856
Name:LIGHTHOUSE SPA LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/PRACTITIONER
Authorized Official - Phone:530-583-8100
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-5546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 N LAKE BLVD
Practice Address - Street 2:20A
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145-5546
Practice Address - Country:US
Practice Address - Phone:530-583-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty