Provider Demographics
NPI:1376633578
Name:HHC AUGUSTA, INC
Entity Type:Organization
Organization Name:HHC AUGUSTA, INC
Other - Org Name:LIGHTHOUSE CARE CENTER OF AUGUSTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SRVP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:3100 PERIMETER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4583
Mailing Address - Country:US
Mailing Address - Phone:706-651-0005
Mailing Address - Fax:706-650-7666
Practice Address - Street 1:3100 PERIMETER PARKWAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4583
Practice Address - Country:US
Practice Address - Phone:706-651-0005
Practice Address - Fax:706-650-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121692283Q00000X
GACCI001286322D00000X, 323P00000X
GA121-658323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC885MXHMedicaid
SC892MXHMedicaid
GA238497179AMedicaid
GA238497179BMedicaid