Healthcare Provider Details

I. General information

NPI: 1316814155
Provider Name (Legal Business Name): LIGHTHOUSE ADULT DAY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 FAIRFAX RD
TOLEDO OH
43613-5119
US

IV. Provider business mailing address

2152 FAIRFAX RD
TOLEDO OH
43613-5119
US

V. Phone/Fax

Practice location:
  • Phone: 419-276-8997
  • Fax:
Mailing address:
  • Phone: 419-276-8997
  • 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: MR. BILLY JAMES JEFFERSON JR.
Title or Position: OWNER
Credential:
Phone: 419-276-8997