Healthcare Provider Details

I. General information

NPI: 1831457506
Provider Name (Legal Business Name): LIGHTHOUSE YOUTH SERVICES INC. - AOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MCMILLAN ST
CINCINNATI OH
45206-1922
US

IV. Provider business mailing address

401 E MCMILLAN ST
CINCINNATI OH
45206-1922
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-3350
  • Fax:
Mailing address:
  • Phone: 513-221-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. THAD PARKER
Title or Position: VICE PRESDIENT BUSINESS MANAGER
Credential:
Phone: 513-487-7137