Provider Demographics
NPI:1871327841
Name:LIGHTHOUSE POINT SUPPORT SERVICES
Entity type:Organization
Organization Name:LIGHTHOUSE POINT SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELORME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-674-5475
Mailing Address - Street 1:315 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2963
Mailing Address - Country:US
Mailing Address - Phone:732-674-5475
Mailing Address - Fax:
Practice Address - Street 1:315 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2963
Practice Address - Country:US
Practice Address - Phone:732-674-5475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities