Provider Demographics
NPI:1073534756
Name:LIGHTHOUSE HEALTHCARE INC
Entity Type:Organization
Organization Name:LIGHTHOUSE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-550-1400
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:8394 G TERMINAL RD
Mailing Address - City:NEWINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22122-1043
Mailing Address - Country:US
Mailing Address - Phone:703-550-1400
Mailing Address - Fax:
Practice Address - Street 1:8394 G TERMINAL RD
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079
Practice Address - Country:US
Practice Address - Phone:703-550-1400
Practice Address - Fax:703-550-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01120251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA196347OtherHEALTH KEEPERS PROVIDER #
VA196347OtherHEALTH KEEPERS PROVIDER #