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General NPI Number Information
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NPI Number | 1295890291
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE FAMILY INJURY CARE
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 760 W SAMPLE RD SUITE #9
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City | POMPANO BEACH
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State | FL
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Zip | 33064-2768
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Country | US
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Telephone | 954-943-6348
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Fax | 954-943-0228
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Provider Business Mailing Address
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Address Line | PO BOX 5068
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33074-5068
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Country | US
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Telephone | 954-943-6348
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Fax | 954-943-0228
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANNE F FERNANDES
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Credential | LMT
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Telephone | 954-943-6348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | HCC4989
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License Number State | FL
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