Provider Demographics
NPI:1689418493
Name:LIGHTHOUSE HOSPICE, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-859-9759
Mailing Address - Street 1:371 KLEINPETER DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-7821
Mailing Address - Country:US
Mailing Address - Phone:985-859-9759
Mailing Address - Fax:
Practice Address - Street 1:5857 N HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:LA
Practice Address - Zip Code:70374-2230
Practice Address - Country:US
Practice Address - Phone:985-859-9759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based