OrganizationActive
Lighthouse Independent Living
NPI 1053548099 · Developmentally Disabled Services Day Training Agency · Johnson City, TN
Provider details
- NPI number
- 1053548099
- Entity type
- Organization
- Primary specialty
- Developmentally Disabled Services Day Training AgencyAgencies
- Organization subpart
- No
- Authorized official
- Lisa Banner, Director(423) 282-5555
- License
- L000000004479 (TN)
Specialties & taxonomies
Agencies
Practice location
2882 Boones Creek Rd
Johnson City, TN 37615-4655
Phone: (423) 282-5555
Fax: (423) 282-6106
Approximate (ZIP-level) locationGet directions
Mailing address
2882 Boones Creek Rd
Johnson City, TN 37615-4655
Registry dates
- Enumerated
- 2009-06-17
- Last updated
- 2009-06-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.