Healthcare Provider Details

I. General information

NPI: 1487159240
Provider Name (Legal Business Name): LIGHTHOUSE HEALTHCARE FACILITIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 SCHOMBURG RD
COLUMBUS GA
31909-3449
US

IV. Provider business mailing address

6450 SCHOMBURG RD
COLUMBUS GA
31909-3449
US

V. Phone/Fax

Practice location:
  • Phone: 706-392-1866
  • Fax: 706-221-9206
Mailing address:
  • Phone: 706-392-1866
  • Fax: 706-221-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAC000201
License Number StateGA

VIII. Authorized Official

Name: MRS. PATRICIA BULLARD-MANUEL
Title or Position: SECRETARY
Credential:
Phone: 706-315-7723