=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215146600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIGHTHOUSE HOME HEALTH CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 08/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28175 HAGGERTY RD
-----------------------------------------------------
City | NOVI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48377-2903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-359-4028
-----------------------------------------------------
Fax | 772-466-4776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28175 HAGGERTY RD
-----------------------------------------------------
City | NOVI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48377-2903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-359-4028
-----------------------------------------------------
Fax | 772-466-4776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER ADMINISTRATOR
-----------------------------------------------------
Name | MS. CHRYSTAL LYNN BAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-359-4028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | NR30211217
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------