Basic Information
| Provider Information | |||||||||
| NPI: | 1154630408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOWER LIGHTS CHRISTIAN HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432221352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142741455 | ||||||||
| FaxNumber: | 6142741433 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 W STATE ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432221536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142741455 | ||||||||
| FaxNumber: | 6142741433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | ARMSTRONG | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6142741455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QP2300X | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 3132407 | 05 | OH | MEDICAID | 9319022 | 01 | OH | MEDICARE PTAN | OTHER |