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General NPI Number Information
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NPI Number | 1992455745
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Entity Type | Organization
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Legal Business Name | THE LIGHTHOUSE VOC-ED CENTER INC
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 125 SHAW ST
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City | NEW LONDON
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State | CT
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Zip | 06320-4900
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Country | US
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Telephone | 860-445-7626
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 271
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City | OLD MYSTIC
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State | CT
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Zip | 06372-0271
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Country | US
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Telephone | 860-448-4200
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KASSIDY BROWN
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Credential |
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Telephone | 860-445-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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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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