Healthcare Provider Details

I. General information

NPI: 1770661092
Provider Name (Legal Business Name): LIGHTHOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E CARO RD
CARO MI
48723-9319
US

IV. Provider business mailing address

PO BOX 289 1655 E CARO RD
CARO MI
48723-0289
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-2500
  • Fax: 989-673-3356
Mailing address:
  • Phone: 989-673-2500
  • Fax: 989-673-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS ATKINS
Title or Position: CFO
Credential:
Phone: 989-673-2500