MEDICARE: LIGHTHOUSE COMMUNITY HHA, LLC

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	1611981	OH

General Provider Information

NPI Number	:	1134382682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE COMMUNITY HHA, LLC

Provider Business Mailing Address
First Line	:	3799 SHAMROCK DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-3357
Country	:	US
Telephone Number	:	614-725-1071
Fax Number	:	614-237-2021

Provider Business Practice Location Address
First Line	:	3799 SHAMROCK DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-3357
Country	:	US
Telephone Number	:	614-725-1071
Fax Number	:	614-237-2021

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. DARLENE R EDWARDS
Credential	:
Telephone Number	:	614-725-1071

Provider Enumeration Date	:	07/04/2008
Last Update Date	:	07/04/2008

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