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NPI Code Detail

MEDICARE: LIGHTHOUSE KIDS LLC

MEDICARE: LIGHTHOUSE KIDS 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
1251B00000XCase Management Agency
2252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1437812153
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHTHOUSE KIDS LLC
Provider Business Mailing Address
First Line : 253 CORBIN PL
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-4901
Country : US
Telephone Number : 917-497-6168
Fax Number :
Provider Business Practice Location Address
First Line : 253 CORBIN PL
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-4901
Country : US
Telephone Number : 917-497-6168
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : PAUL KRANTS
Credential :
Telephone Number : 917-497-6168
Provider Enumeration Date : 10/19/2021
Last Update Date : 04/25/2022

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Directions to “LIGHTHOUSE KIDS LLC ” Practice Location

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