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Organization

LIGHTHOUSE HOME CARE PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS REGINA SHANNON RN (OWNER)
(612) 529-0010
Entity
Organization

Contact information

Practice address
617 W BROADWAY AVE, MINNEAPOLIS, MN 55411-2712
(612) 529-0010
(612) 529-0010
Mailing address
617 W BROADWAY AVE, MINNEAPOLIS, MN 55411-2712
(612) 529-0010
(612) 529-0010

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
376314
MN

Other

Enumeration date
04/22/2016
Last updated
04/22/2016
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