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NPI Code Detail

MEDICARE: LIGHTHOUSE YOUTH SERVICES INC. - AOD

MEDICARE: LIGHTHOUSE YOUTH SERVICES INC. - AOD
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
1291U00000XClinical Medical Laboratory
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

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

General Provider Information

NPI Number : 1831457506
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHTHOUSE YOUTH SERVICES INC. - AOD
Provider Business Mailing Address
First Line : 401 E MCMILLAN ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45206-1922
Country : US
Telephone Number : 513-221-3350
Fax Number :
Provider Business Practice Location Address
First Line : 401 E MCMILLAN ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45206-1922
Country : US
Telephone Number : 513-221-3350
Fax Number :
Authorized Official
Title or Position : VICE PRESDIENT BUSINESS MANAGER
Name : MR. THAD PARKER
Credential :
Telephone Number : 513-487-7137
Provider Enumeration Date : 05/01/2012
Last Update Date : 04/07/2025

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