Provider Demographics
NPI:1144589193
Name:LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Entity Type:Organization
Organization Name:LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:VALLANGEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-272-7639
Mailing Address - Street 1:1251 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1359
Mailing Address - Country:US
Mailing Address - Phone:614-274-1455
Mailing Address - Fax:614-274-1433
Practice Address - Street 1:777 W STATE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1536
Practice Address - Country:US
Practice Address - Phone:614-234-5953
Practice Address - Fax:614-274-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH361982OtherMEDICARE