Provider Demographics
NPI:1174899454
Name:LIGHT HORSE HEALTHCARE INC
Entity type:Organization
Organization Name:LIGHT HORSE HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-882-3800
Mailing Address - Street 1:PO BOX 5250
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558
Mailing Address - Country:US
Mailing Address - Phone:912-882-3800
Mailing Address - Fax:912-882-3303
Practice Address - Street 1:2060 DAN PROCTOR DRIVE
Practice Address - Street 2:SUITE 3300
Practice Address - City:ST MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558
Practice Address - Country:US
Practice Address - Phone:912-882-3800
Practice Address - Fax:912-882-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable