=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700549755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2021
-----------------------------------------------------
Last Update Date | 10/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 PRICE RD
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43055-9506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-274-1455
-----------------------------------------------------
Fax | 614-274-1433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 675 PRICE RD
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43055-9506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-274-1455
-----------------------------------------------------
Fax | 614-274-1433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING DIRECTOR
-----------------------------------------------------
Name | MICHELLE ARMSTRONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-274-1455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------