Healthcare Provider Details

I. General information

NPI: 1467592162
Provider Name (Legal Business Name): OPERATION LIGHTHOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SAYLES BLVD
ABILENE TX
79605-2001
US

IV. Provider business mailing address

125 SAYLES BLVD
ABILENE TX
79605-2001
US

V. Phone/Fax

Practice location:
  • Phone: 325-670-9577
  • Fax: 325-670-6040
Mailing address:
  • Phone: 325-670-9577
  • Fax: 325-670-6040

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. RICKY R FELTS
Title or Position: PRESIDENT
Credential:
Phone: 325-670-9577