MEDICARE: LIGHTHOUSE COMMUNITY CARE INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1124580303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE COMMUNITY CARE INC

Provider Business Mailing Address
First Line	:	4500 LEE RD STE 231
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 LEE RD STE 231
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2959
Country	:	US
Telephone Number	:	401-556-6017
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANA CURRAIS
Credential	:
Telephone Number	:	401-556-6017

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	10/30/2019

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