Provider Demographics
NPI: | 1619643285 |
---|---|
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: | BILLING & CREDENTIALING DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ARMSTRONG |
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: | 2028 CLEVELAND AVE |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43211-2214 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-274-1455 |
Practice Address - Fax: | 614-274-1433 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-08-23 |
Last Update Date: | 2021-08-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |