Provider Demographics
NPI:1861523086
Name:LIGHTHOUSE REHABILITATION LLC
Entity type:Organization
Organization Name:LIGHTHOUSE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-522-1095
Mailing Address - Street 1:981 FOREST CT
Mailing Address - Street 2:
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-1478
Mailing Address - Country:US
Mailing Address - Phone:316-522-1095
Mailing Address - Fax:
Practice Address - Street 1:CLEARWATER RETIREMENT COMMUNITY
Practice Address - Street 2:620 EAST WOOD STREET
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026
Practice Address - Country:US
Practice Address - Phone:620-584-2271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility