Provider Demographics
NPI:1649045774
Name:LIGHTHOUSE ADVOCACY AGENCY LLC
Entity type:Organization
Organization Name:LIGHTHOUSE ADVOCACY AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-327-9218
Mailing Address - Street 1:6100 OAK TREE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6914
Mailing Address - Country:US
Mailing Address - Phone:216-327-9218
Mailing Address - Fax:216-643-2901
Practice Address - Street 1:6100 OAK TREE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6914
Practice Address - Country:US
Practice Address - Phone:216-327-9218
Practice Address - Fax:216-643-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health