NPIMap

Organization Active NPI

Lighthouse, Inc.

  • Rehabilitation Clinic/Center
  • Caro, MI
National Provider Identifier
1770661092
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
LIGHTHOUSE, INC.
Practice address
1655 E Caro Rd
Caro, MI 48723-9319
Phone
(989) 673-2500
Fax
(989) 673-3356
NPI assigned
Nov 2, 2006
Last updated
Oct 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Authorized official

Name
Dennis Atkins
Title
Cfo
Phone
(989) 673-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

1655 E Caro Rd
Caro, MI 48723-9319

Mailing address

PO Box 289
1655 E Caro Rd
Caro, MI 48723-0289
Phone (989) 673-2500

Other identifiers 2

IdentifierTypeStateIssuer
30744OtherMIBLUE CROSS PROVIDER NUMBE
0990686OtherMIHEALTH PLUS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090910000635 MI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 8325193535 Practice locations: Caro, MI; Kingsley, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770661092. Details of each certification follow.

  • CCN 236771 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 236771

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LIGHTHOUSE
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jul 19, 2000
Last certification
Dec 3, 2020
Ownership / control type
Proprietary
Facility address
1655 East Caro Road
Caro, MI 48723

National Provider Directory

National Provider Directory
Tax ID family
Lighthouse Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4040 Beacon St
Kingsley, MI 49649
Phone (231) 263-1350

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1770661092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 289",
            "address_2": "1655 E CARO RD",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487230289",
            "telephone_number": "989-673-2500",
            "fax_number": "989-673-3356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 E CARO RD",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487239319",
            "telephone_number": "989-673-2500",
            "fax_number": "989-673-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "ATKINS",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "989-673-2500"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "30744",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS",
            "identifier": "0990686",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caro, MI

Sources for this page

Verify at the official NPI Registry.