Organization
LIGHTHOUSE INDEPENDENT LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA RENEE BANNER (DIRECTOR)
(423) 282-5555
Entity
Organization
Contact information
Practice address
2882 BOONES CREEK RD, JOHNSON CITY, TN 37615-4655
(423) 282-5555
(423) 282-6106
Mailing address
2882 BOONES CREEK RD, JOHNSON CITY, TN 37615-4655
(423) 282-5555
(423) 282-6106
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
L000000004479
TN
Other
Enumeration date
06/17/2009
Last updated
06/17/2009
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