Provider Demographics
NPI:1144666124
Name:LIGHTHORSE HEALTHCARE INC.
Entity type:Organization
Organization Name:LIGHTHORSE HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-882-3800
Mailing Address - Street 1:PO BOX 5250
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-5250
Mailing Address - Country:US
Mailing Address - Phone:912-882-3800
Mailing Address - Fax:912-882-3303
Practice Address - Street 1:87 LINDSEY LN STE B
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6923
Practice Address - Country:US
Practice Address - Phone:912-882-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty