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General NPI Number Information
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NPI Number | 1205771821
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 1515 N UNIVERSITY DR STE 207
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-6067
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Country | US
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Telephone | 754-241-3155
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Fax | 866-635-1584
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Provider Business Mailing Address
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Address Line | 1515 N UNIVERSITY DR STE 207
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-6067
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Country | US
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Telephone | 754-241-3155
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Fax | 866-635-1584
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | ALTIA LANDIS
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Credential | APRN
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Telephone | 754-241-3155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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