MEDICARE: LIGHTHOUSE COMMUNITY 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1598498180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE COMMUNITY HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	59 GOLD HILL ELEMENTARY SCHOOL RD STE B
Second Line	:
City	:	NEW CANTON
State	:	VA
Zip	:	23123-2162
Country	:	US
Telephone Number	:	434-847-5050
Fax Number	:	434-215-3993

Provider Business Practice Location Address
First Line	:	59 GOLD HILL ELEMENTARY SCHOOL RD STE B
Second Line	:
City	:	NEW CANTON
State	:	VA
Zip	:	23123-2162
Country	:	US
Telephone Number	:	434-581-4904
Fax Number	:	434-215-3993

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MARSHA BEST
Credential	:
Telephone Number	:	434-847-5050

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	06/06/2023

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