MEDICARE: THE LIGHTHOUSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	NV20131588522	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225466709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LIGHTHOUSE LLC

Provider Business Mailing Address
First Line	:	5710 E TROPICANA AVE #2212
Second Line	:
City	:	LAS VEGAS
State	:	NEVADA
Zip	:	89122
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5710 E TROPICANA AVE #2212
Second Line	:
City	:	LAS VEGAS
State	:	NEVADA
Zip	:	89122
Country	:	UM
Telephone Number	:	702-884-4049
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SOLANGE BEEVERS
Credential	:
Telephone Number	:	702-884-4049

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	10/22/2013

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Directions to “THE LIGHTHOUSE LLC ” Practice Location

Language	Start Address	Practice Location

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