MEDICARE: LIGHTHOUSE OF BROWARD COUNTY, INC.

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	253Z00000X	In Home Supportive Care Agency		FL

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

General Provider Information

NPI Number	:	1932336187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE OF BROWARD COUNTY, INC.

Provider Business Mailing Address
First Line	:	650 N ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-7436
Country	:	US
Telephone Number	:	954-463-4217
Fax Number	:	954-764-3825

Provider Business Practice Location Address
First Line	:	650 N ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-7436
Country	:	US
Telephone Number	:	954-463-4217
Fax Number	:	954-764-3825

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. ELLY DU PRE
Credential	:	DPA
Telephone Number	:	954-463-4217

Provider Enumeration Date	:	06/15/2009
Last Update Date	:	06/15/2009

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