NPI 1053548099

Lighthouse Independent Living

Organisation Developmentally Disabled Services Day Training Agency Johnson City, TN

Practice location

Address: 2882 Boones Creek Rd, Johnson City, TN 37615-4655
Phone: (423) 282-5555
Fax: (423) 282-6106

Authorised official

Name: Lisa Renee Banner
Title: Director
Phone: (423) 282-5555

Registered specialties

Developmentally Disabled Services Day Training Agency Primary

Agencies Taxonomy 251C00000X Licence L000000004479 (TN)

Other Day Training, Developmentally Disabled Services providers in Tennessee →

Registry record

NPI: 1053548099
Entity type: Organization
NPI issued: 17 Jun 2009
Record last updated: 17 Jun 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.