MEDICARE: LIGHTHOUSE HEALTHCARE FACILITIES, 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	261QA0600X	Adult Day Care Clinic/Center	AC000201	GA

General Provider Information

NPI Number	:	1487159240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE HEALTHCARE FACILITIES, INC

Provider Business Mailing Address
First Line	:	6450 SCHOMBURG RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3449
Country	:	US
Telephone Number	:	706-392-1866
Fax Number	:	706-221-9206

Provider Business Practice Location Address
First Line	:	6450 SCHOMBURG RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3449
Country	:	US
Telephone Number	:	706-392-1866
Fax Number	:	706-221-9206

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. PATRICIA BULLARD-MANUEL
Credential	:
Telephone Number	:	706-315-7723

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	08/17/2018

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