Provider Demographics
NPI:1366597965
Name:LIGHTHOUSE HOME HEALTH CARE
Entity type:Organization
Organization Name:LIGHTHOUSE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROMARTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-760-1812
Mailing Address - Street 1:1381 OLD MILL CIR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1400
Mailing Address - Country:US
Mailing Address - Phone:336-760-1812
Mailing Address - Fax:336-760-1727
Practice Address - Street 1:1381 OLD MILL CIR
Practice Address - Street 2:SUITE 130
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1400
Practice Address - Country:US
Practice Address - Phone:336-760-1812
Practice Address - Fax:336-760-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3208251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601433Medicaid