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General NPI Number Information
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NPI Number | 1083011506
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE HEALTHCARE MANAGEMENT NORTH LLC
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 3208 NE 11TH ST
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3910
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Country | US
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Telephone | 954-943-6318
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Fax |
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Provider Business Mailing Address
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Address Line | 555 MADISON AVE 19TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10022-3301
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Country | US
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Telephone | 212-616-8819
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | SAMUEL TENNENBAUM
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Credential |
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Telephone | 212-616-8819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL8339
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License Number State | FL
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