=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861359697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIGHTHOUSE HOME HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 LOS CASTILLOS
-----------------------------------------------------
City | BERNALILLO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87004-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-584-3364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 CALLE DEL PRESIDENTE UNIT 125
-----------------------------------------------------
City | BERNALILLO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87004-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/CEO
-----------------------------------------------------
Name | AUDRA CASTILLO
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 505-584-3364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------