Healthcare Provider Details

I. General information

NPI: 1861359697
Provider Name (Legal Business Name): LIGHTHOUSE HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LOS CASTILLOS
BERNALILLO NM
87004-5900
US

IV. Provider business mailing address

145 CALLE DEL PRESIDENTE UNIT 125
BERNALILLO NM
87004-2006
US

V. Phone/Fax

Practice location:
  • Phone: 505-584-3364
  • Fax:
Mailing address:
  • Phone:
  • 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: AUDRA CASTILLO
Title or Position: FOUNDER/CEO
Credential: RN
Phone: 505-584-3364