Healthcare Provider Details

I. General information

NPI: 1912620162
Provider Name (Legal Business Name): LIGHTHOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 CENTRAL ST
KANSAS CITY MO
64111-1323
US

IV. Provider business mailing address

11300 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2721
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-2233
  • Fax:
Mailing address:
  • Phone: 314-739-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDY HELTON
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 314-739-6811