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General NPI Number Information
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NPI Number | 1255963153
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COMMUNITY CENTER LLC
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Dates
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Enumeration Date | 02/08/2020
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Last Update Date | 02/08/2020
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Provider Practice Location Address
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Address Line | 7855 NW 12TH ST STE 117
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City | DORAL
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State | FL
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Zip | 33126-1818
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Country | US
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Telephone | 786-487-7006
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Fax |
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Provider Business Mailing Address
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Address Line | 7855 NW 12TH ST STE 117
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City | DORAL
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State | FL
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Zip | 33126-1818
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Country | US
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Telephone | 786-487-7006
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORENA NATALIA OSELLA
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Credential |
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Telephone | 786-487-7006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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