Provider Demographics
NPI:1861454829
Name:LIGHTHOUSE HOSPICE INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-977-9711
Mailing Address - Street 1:500 FAULCONER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903
Mailing Address - Country:US
Mailing Address - Phone:434-977-9711
Mailing Address - Fax:
Practice Address - Street 1:200 LAKE DR E STE 205
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:856-414-1155
Practice Address - Fax:856-414-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22871251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7253800Medicaid
NJ7253800Medicaid
NJ0868373OtherPROVIDER NUMBER
NJ1160710OtherPROVIDER NUMBER
NJA3634717OtherPROVIDER NUMBER
NJ0868373OtherPROVIDER NUMBER