Light House Group Home
Organization Active NPI In Home Supportive Care Agency · Tryon, NC
NPI 1013392679 · NPPES record last updated May 5, 2022
Key facts
- NPI
- 1013392679
- Entity type
- Organization (NPI type 2)
- Primary specialty
- In Home Supportive Care Agency 253Z00000X
- Legal business name
- LIGHT HOUSE GROUP HOME
- Practice address
- 85 Mimosa Inn LN
Tryon, NC 28782-8685 - Phone
- (828) 859-0259
- NPI assigned
- Jul 24, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- SYNERGY IN ACTION
Authorized official
- Name
- Julie Grigg
- Title
- Executive Administrator
- Phone
- (828) 859-0259
Parent organization (reported in NPPES) 1
Corporate family (same tax ID) 4
National Provider Directory
- Tax ID family
- Peniel 1 Group Home
- Part of
- Peniel 1 Group Home
Locations
20 Jervey Rd
Ste 102
Tryon, NC 28782
Phone (828) 859-2780
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | Yes | ||
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | MHL075025 | NC |
Addresses
Primary practice location
85 Mimosa Inn LN
Tryon, NC 28782-8685
Mailing address
20 Jervey Rd
Suite 102
Tryon, NC 28782-0017
Phone (828) 859-0259
Other providers in Tryon, NC
- Laura Budd Ellington LCSW, Lisw-CP
- Laurellyn Medical Group
- Jeffrey Ian Lewis
- Librick, Inc.
- Librick, Inc.
- Stephanie Regina Lindsay
- Luminous Enterprises, L.L.C.
- John Malloy
- Jennifer Mathews
- McCall & McCall , D.D.S., P.a.
All providers in Tryon, NC · In Home Supportive Care Agency in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.