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General NPI Number Information
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NPI Number | 1083421788
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Entity Type | Organization
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Legal Business Name | CARRIE'S LIGHTHOUSE LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 803 WOOSTER RD N
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City | BARBERTON
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State | OH
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Zip | 44203-1664
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Country | US
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Telephone | 330-607-2048
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Fax |
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Provider Business Mailing Address
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Address Line | 803 WOOSTER RD N
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City | BARBERTON
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State | OH
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Zip | 44203-1664
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Country | US
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Telephone | 330-475-2234
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KELLY PRIGMORE
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Credential |
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Telephone | 330-475-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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