Provider Demographics
NPI:1447549621
Name:LIGHTHOUSE FOSTER CARE, LLC.
Entity type:Organization
Organization Name:LIGHTHOUSE FOSTER CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:TAMSAMOA
Authorized Official - Last Name:AHQUIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:435-229-4889
Mailing Address - Street 1:50 E 100 S
Mailing Address - Street 2:SUITE #204
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2318
Mailing Address - Country:US
Mailing Address - Phone:435-229-4889
Mailing Address - Fax:877-628-3606
Practice Address - Street 1:50 E 100 S
Practice Address - Street 2:SUITE #204
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2318
Practice Address - Country:US
Practice Address - Phone:435-229-4889
Practice Address - Fax:877-628-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17321253J00000X
UT17746261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health