Provider Demographics
NPI:1134382682
Name:LIGHTHOUSE COMMUNITY HHA, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE COMMUNITY HHA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-725-1071
Mailing Address - Street 1:3799 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3357
Mailing Address - Country:US
Mailing Address - Phone:614-725-1071
Mailing Address - Fax:614-237-2021
Practice Address - Street 1:3799 SHAMROCK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3357
Practice Address - Country:US
Practice Address - Phone:614-725-1071
Practice Address - Fax:614-237-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-04
Last Update Date:2008-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1611981251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health