Provider Demographics
NPI:1659909182
Name:LIGHTHOUSE OF COLUMBUS, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE OF COLUMBUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-442-7783
Mailing Address - Street 1:6634 FORREST RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-3037
Mailing Address - Country:US
Mailing Address - Phone:706-442-7783
Mailing Address - Fax:
Practice Address - Street 1:6634 FORREST RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3037
Practice Address - Country:US
Practice Address - Phone:706-442-7783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care