Healthcare Provider Details

I. General information

NPI: 1083421788
Provider Name (Legal Business Name): CARRIE'S LIGHTHOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 WOOSTER RD N
BARBERTON OH
44203-1664
US

IV. Provider business mailing address

803 WOOSTER RD N
BARBERTON OH
44203-1664
US

V. Phone/Fax

Practice location:
  • Phone: 330-607-2048
  • Fax:
Mailing address:
  • Phone: 330-475-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY PRIGMORE
Title or Position: MANAGER
Credential:
Phone: 330-475-2234