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General NPI Number Information
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NPI Number | 1275957557
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Entity Type | Organization
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Legal Business Name | LOWER LIGHTS CHRISTIAN HEALTH CENTER, INC
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 773 S WALNUT ST
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City | MARYSVILLE
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State | OH
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Zip | 43040-1643
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Country | US
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Telephone | 614-274-1455
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Fax | 614-272-2333
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Provider Business Mailing Address
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Address Line | 1160 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43222-1317
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Country | US
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Telephone | 614-274-1455
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Fax | 614-272-2333
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Authorized Official
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Title or Position | CEO
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Name | MRS. DANA S VALLANGEON
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Credential | M.D.
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Telephone | 614-274-1455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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