MEDICARE: LIGHTHOUSE SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1174391569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE SERVICES LLC

Provider Business Mailing Address
First Line	:	12728 BEARSDALE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-6072
Country	:	US
Telephone Number	:	317-724-4940
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 N GERMAN CHURCH RD STE 102
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-8513
Country	:	US
Telephone Number	:	317-210-0878
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATIONS MANAGER
Name	:	MRS. JOYCE MILLER
Credential	:
Telephone Number	:	317-210-0878

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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