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Contact Information

LIGHTHOUSE SUPPORT SERVICES LLC
7516 E MAIN ST STE 1
MESA, AZ85207-8332
 Phone: 602-526-0302
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Adult Mental Health

261QM0850X
 

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
 

Community/Behavioral Health

251S00000X
 

Substance Abuse Disorder Rehabilitation Facility

324500000X
Indicates primary specialty

NPI Profile & details for LIGHTHOUSE SUPPORT SERVICES LLC

NPI # 1033817333
LBN Legal business name LIGHTHOUSE SUPPORT SERVICES LLC
Authorized official JESSICA EVANS - (ADMIN)
Entity Organization
Organization subpart 1 No
Enumeration date 02/16/2023
Last updated 03/15/2024 - About 2 years ago
Identifiers
AZ Medicaid 123007
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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