Lighthouse Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

LIGHTHOUSE HOSPICE LLC

Practice address

2667 E Gala CT Ste 100
Meridian, ID 83642-2792

Phone

(208) 576-6383

Fax

(208) 884-4048

NPI assigned

Nov 28, 2016

Organization subpart

No

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

Authorized official

Name

Kellie Anne Stanger, RN

Title

Administrator

Phone

(208) 576-6383

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Hospice certification: CCN 131580

Legal name

LIGHTHOUSE HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 30, 2017

Last certification

Nov 30, 2017

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Nov 21, 2016 in ID

Enrollment address

2667 E Gala CT
Ste 100
Meridian, ID 83642-2792

Listed as

Lighthouse Hospice LLCCCN 131580

Ownership

For-Profit

Certified

Nov 30, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Daniel J Broderick, DO

  • Hospitalist Physician
  • Boise, ID
  • NPI 1487141990

  Hospice

  Care Compare affiliation
• David Palmer McAdams, D.O.

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1326407248

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1477096220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2667 E GALA CT STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422792",
            "telephone_number": "208-576-6383",
            "fax_number": "208-884-4048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2667 E GALA CT STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422792",
            "telephone_number": "208-576-6383",
            "fax_number": "208-884-4048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "STANGER",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-576-6383",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Maddie Liddiard, LMSW
• Lifefill III, LLC
• Lifespan Wellness PLLC
• Lauren Rebeccca Liles
• Lily and Loom Counseling LLC
• Rodney Dale Limb, LCPC, LMFT, LPC
• Limitless Life Counseling, LLC
• Zirui Lin

• Community Based Hospice Care Agency in Meridian, ID
• Providers in Meridian, ID by specialty
• Community Based Hospice Care Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.