Provider Demographics
NPI:1295913846
Name:LIGHTHOUSE HOME MEDICAL
Entity type:Organization
Organization Name:LIGHTHOUSE HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-738-1770
Mailing Address - Street 1:3281 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-9016
Mailing Address - Country:US
Mailing Address - Phone:386-738-1770
Mailing Address - Fax:386-740-7523
Practice Address - Street 1:3281 MARSH RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-9016
Practice Address - Country:US
Practice Address - Phone:386-738-1770
Practice Address - Fax:386-740-7523
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE EQUIPMENT MANAGMENT SERVICE AND REPAIR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies