Provider Demographics
NPI:1619541653
Name:LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Entity Type:Organization
Organization Name:LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Other - Org Name:LOWER LIGHTS HOPE RESOURCE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-274-1455
Mailing Address - Street 1:1160 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1352
Mailing Address - Country:US
Mailing Address - Phone:614-274-1455
Mailing Address - Fax:614-274-1433
Practice Address - Street 1:496 S WHEATLAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3110
Practice Address - Country:US
Practice Address - Phone:614-274-1455
Practice Address - Fax:614-274-1433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-14
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0477976Medicaid