MEDICARE: LIGHTHOUSE HEALTHCARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063715357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	8304 S COURSE DR APT 913
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-4480
Country	:	US
Telephone Number	:	281-879-0650
Fax Number	:

Provider Business Practice Location Address
First Line	:	8304 S COURSE DR APT 913
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-4480
Country	:	US
Telephone Number	:	281-879-0650
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHARMAINE RENEE GRAY
Credential	:
Telephone Number	:	281-879-0650

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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Directions to “LIGHTHOUSE HEALTHCARE SERVICES ” Practice Location

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