1568606879 NPI number — LIGHTHOUSE COMMUNITY SCHOOL

Table of content: (NPI 1568606879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568606879 NPI number — LIGHTHOUSE COMMUNITY SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIGHTHOUSE COMMUNITY SCHOOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568606879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 E. MCMILLAN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45206-1922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-487-7106
Provider Business Mailing Address Fax Number:
513-221-3665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 DESMOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45220-1897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-561-7888
Provider Business Practice Location Address Fax Number:
513-561-7818
Provider Enumeration Date:
04/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WINTHER
Authorized Official First Name:
MARILON
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
513-487-7106

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  ZOO , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)