Lighthouse Independent Living

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

L000000004479 Issued in TN

Legal business name

LIGHTHOUSE INDEPENDENT LIVING

Practice address

2882 Boones Creek Rd
Johnson City, TN 37615-4655

Phone

(423) 282-5555

Fax

(423) 282-6106

NPI assigned

Jun 17, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lisa Renee Banner

Title

Director

Phone

(423) 282-5555

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245196800000",
    "number": "1053548099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2882 BOONES CREEK RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154655",
            "telephone_number": "423-282-5555",
            "fax_number": "423-282-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2882 BOONES CREEK RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154655",
            "telephone_number": "423-282-5555",
            "fax_number": "423-282-6106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE INDEPENDENT LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-17",
        "last_updated": "2009-06-17",
        "status": "A",
        "authorized_official_last_name": "BANNER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "423-282-5555",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "TN",
            "license": "L000000004479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Developmentally Disabled Services Day Training Agency in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.