Provider Demographics
NPI:1134759764
Name:THE LIGHTHOUSE COMMUNITY HOSPICE INC
Entity type:Organization
Organization Name:THE LIGHTHOUSE COMMUNITY HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-759-1960
Mailing Address - Street 1:1029 MEREDITH PARK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7557
Mailing Address - Country:US
Mailing Address - Phone:678-759-1960
Mailing Address - Fax:678-623-3455
Practice Address - Street 1:1029 MEREDITH PARK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7557
Practice Address - Country:US
Practice Address - Phone:678-759-1960
Practice Address - Fax:678-623-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based