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General NPI Number Information
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NPI Number | 1073822318
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE LIVING SERVICES, INC.
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 3600 POWER INN RD SUITE H1
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City | SACRAMENTO
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State | CA
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Zip | 95826-3826
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Country | US
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Telephone | 916-454-4381
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Fax | 916-454-1497
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Provider Business Mailing Address
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Address Line | 3600 POWER INN RD SUITE H1
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City | SACRAMENTO
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State | CA
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Zip | 95826-3826
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Country | US
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Telephone | 916-454-4381
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Fax | 916-454-1497
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TABIAS CHRISTOPHER COWAN
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Credential |
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Telephone | 916-454-4381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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