MEDICARE: LIGHTHOUSE PRIMARY HOME CARE 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
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1851666200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE PRIMARY HOME CARE LLC

Provider Business Mailing Address
First Line	:	1716 S SAN MARCOS
Second Line	:	SUITE 27
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-7094
Country	:	US
Telephone Number	:	210-444-1825
Fax Number	:	210-223-9128

Provider Business Practice Location Address
First Line	:	1716 S SAN MARCOS
Second Line	:	SUITE 27
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-7094
Country	:	US
Telephone Number	:	210-444-1825
Fax Number	:	210-223-9128

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. ARMANDO NATIVIDAD
Credential	:
Telephone Number	:	210-444-1825

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/20/2012

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