Provider Demographics
NPI:1801544614
Name:LIGHTHOUSE TRANSIT
Entity type:Organization
Organization Name:LIGHTHOUSE TRANSIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-900-4020
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-1420
Mailing Address - Country:US
Mailing Address - Phone:803-900-4020
Mailing Address - Fax:803-753-9362
Practice Address - Street 1:437A HIGHWAY 601 S
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8918
Practice Address - Country:US
Practice Address - Phone:803-900-4020
Practice Address - Fax:803-753-9362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)