Provider Demographics
NPI:1487986600
Name:LIGHTED PATH RECOVERY SERVICES
Entity type:Organization
Organization Name:LIGHTED PATH RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATHERYN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PLADC
Authorized Official - Phone:402-641-6245
Mailing Address - Street 1:147 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2003
Mailing Address - Country:US
Mailing Address - Phone:402-641-6245
Mailing Address - Fax:402-643-6245
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2047
Practice Address - Country:US
Practice Address - Phone:402-641-6245
Practice Address - Fax:402-646-2045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANNA MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-13
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-824261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service