MEDICARE: LIGHTHOUSE HOME HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1457993560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE HOME HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	1922 WILLOW WISP LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-6243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 WILLOW WISP LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-6243
Country	:	US
Telephone Number	:	713-322-5331
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BRANDON EVANS
Credential	:
Telephone Number	:	713-322-5331

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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