Provider Demographics
NPI:1902871072
Name:LIGHTHOUSE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE ASSOCIATES, LLC
Other - Org Name:LIGHTHOUSE POINTE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:LNHA
Authorized Official - Phone:513-554-1141
Mailing Address - Street 1:21 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3311
Mailing Address - Country:US
Mailing Address - Phone:513-554-1141
Mailing Address - Fax:513-769-5206
Practice Address - Street 1:21 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3311
Practice Address - Country:US
Practice Address - Phone:513-554-1141
Practice Address - Fax:513-769-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6384314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2369306Medicaid
OH366105Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER