Provider Demographics
NPI:1861195554
Name:LANE LIGHT ASSOCIATES, IN
Entity type:Organization
Organization Name:LANE LIGHT ASSOCIATES, IN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-318-8669
Mailing Address - Street 1:PO BOX 2426
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04116-2426
Mailing Address - Country:US
Mailing Address - Phone:207-318-8669
Mailing Address - Fax:207-536-4001
Practice Address - Street 1:18 OCEAN ST STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2849
Practice Address - Country:US
Practice Address - Phone:207-318-8669
Practice Address - Fax:207-536-4001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANE LIGHT ASSOCIATES, IN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty