Provider Demographics
NPI:1548933823
Name:LANTERN LIGHT LIFESTYLE, LLC
Entity type:Organization
Organization Name:LANTERN LIGHT LIFESTYLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SANCHEZ
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:210-914-3193
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-0337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:509 ELM ST
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-3511
Practice Address - Country:US
Practice Address - Phone:210-914-3193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health