Healthcare Provider Details

I. General information

NPI: 1861523086
Provider Name (Legal Business Name): LIGHTHOUSE REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLEARWATER RETIREMENT COMMUNITY 620 EAST WOOD STREET
CLEARWATER KS
67026
US

IV. Provider business mailing address

981 FOREST CT
HAYSVILLE KS
67060-1478
US

V. Phone/Fax

Practice location:
  • Phone: 620-584-2271
  • Fax:
Mailing address:
  • Phone: 316-522-1095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EDDIE A LIGHT
Title or Position: CEO
Credential:
Phone: 316-522-1095