Provider Demographics
NPI:1902263643
Name:THE LIGHTHOUSE COMMUNITY CARE
Entity Type:Organization
Organization Name:THE LIGHTHOUSE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:BACHLORS DEGREE
Authorized Official - Phone:985-870-4599
Mailing Address - Street 1:120 RUSTY LANE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-0120
Mailing Address - Country:US
Mailing Address - Phone:985-870-4599
Mailing Address - Fax:
Practice Address - Street 1:120 RUSTY LANE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-0120
Practice Address - Country:US
Practice Address - Phone:985-870-4599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOC24442302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization