1790814440 NPI number — LITE HOUSE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790814440 NPI number — LITE HOUSE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITE HOUSE, INC.
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:
1790814440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 GOVERNMENT AVE SW
Provider Second Line Business Mailing Address:
STE 304-A
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28602-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-355-5811
Provider Business Mailing Address Fax Number:
800-688-0471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 GOVERNMENT AVE SW
Provider Second Line Business Practice Location Address:
STE 304-A
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-355-5811
Provider Business Practice Location Address Fax Number:
800-688-0471
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TYLER
Authorized Official First Name:
ARNOLD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
828-355-5811

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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