Provider Demographics
NPI:1861757338
Name:LIGHTHOUSE HOME CARE
Entity type:Organization
Organization Name:LIGHTHOUSE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-230-6008
Mailing Address - Street 1:1830 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2544
Mailing Address - Country:US
Mailing Address - Phone:337-233-1865
Mailing Address - Fax:337-233-1881
Practice Address - Street 1:1830 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2544
Practice Address - Country:US
Practice Address - Phone:337-233-1865
Practice Address - Fax:337-233-1881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care