Healthcare Provider Details

I. General information

NPI: 1942166020
Provider Name (Legal Business Name): LIGHTHOUSE PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11174 E 13 MILE RD
WARREN MI
48093-2559
US

IV. Provider business mailing address

11174 E 13 MILE RD
WARREN MI
48093-2559
US

V. Phone/Fax

Practice location:
  • Phone: 313-444-5038
  • Fax:
Mailing address:
  • Phone: 313-444-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALLYSON DOLL ANDREWS
Title or Position: CEO
Credential: MSW
Phone: 313-888-1444