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General NPI Number Information
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NPI Number | 1649626532
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE HOMECARE
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 3565 UTICA RIDGE RD
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City | BETTENDORF
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State | IA
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Zip | 52722-1654
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Country | US
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Telephone | 563-441-9982
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Fax | 563-424-1016
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Provider Business Mailing Address
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Address Line | 3565 UTICA RIDGE RD
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City | BETTENDORF
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State | IA
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Zip | 52722-1654
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Country | US
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Telephone | 563-441-9982
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Fax | 563-424-1016
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Authorized Official
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Title or Position | OWNER
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Name | MR. SCOTT MCNAB
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Credential |
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Telephone | 563-441-9982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 4000444
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3001105
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License Number State | IL
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