Healthcare Provider Details

I. General information

NPI: 1487244364
Provider Name (Legal Business Name): LIGHTHOUSE COMMUNITY HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 CHURCH ST
LYNCHBURG VA
24504-4604
US

IV. Provider business mailing address

1310 CHURCH ST
LYNCHBURG VA
24504-4604
US

V. Phone/Fax

Practice location:
  • Phone: 434-847-5050
  • Fax:
Mailing address:
  • Phone: 434-847-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. FINNY MATHEW
Title or Position: PREIDENT
Credential:
Phone: 434-847-5050