Healthcare Provider Details

I. General information

NPI: 1689594244
Provider Name (Legal Business Name): LIGHTHOUSE RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N UNIVERSITY DR STE 112
CORAL SPRINGS FL
33071-6065
US

IV. Provider business mailing address

1515 N UNIVERSITY DR STE 112
CORAL SPRINGS FL
33071-6065
US

V. Phone/Fax

Practice location:
  • Phone: 754-241-3155
  • Fax: 866-635-1584
Mailing address:
  • Phone: 754-241-3155
  • Fax: 866-635-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ALTIA LANDIS
Title or Position: OWNER
Credential: APRN
Phone: 754-241-3155