Provider Demographics
NPI:1548502727
Name:LIGHTHOUSE FAMILY SERVICES, INC
Entity type:Organization
Organization Name:LIGHTHOUSE FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:407-405-2724
Mailing Address - Street 1:14804 AVENUE OF THE GRVS
Mailing Address - Street 2:11107
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8738
Mailing Address - Country:US
Mailing Address - Phone:407-405-2724
Mailing Address - Fax:
Practice Address - Street 1:14804 AVENUE OF THE GRVS
Practice Address - Street 2:11107
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8738
Practice Address - Country:US
Practice Address - Phone:407-405-2724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management