| Lighthouse Community Care | |
|
921 N Lobdell Ave Suite C1 Baton Rouge LA 70806 | |
| (225) 937-6201 | |
| Not Available |
| Full Name | Lighthouse Community Care |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 921 N Lobdell Ave, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Ben Thomas (CEO/PRESIDENT) |
| Authorized Official Contact | 2259376201 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Community Care Po Box 74462 Baton Rouge LA 70874-4462 Ph: (225) 937-6201 | Lighthouse Community Care 921 N Lobdell Ave Suite C1 Baton Rouge LA 70806 Ph: (225) 937-6201 |
| NPI Number | 1255681128 |
|---|---|
| Provider Enumeration Date | 09/18/2012 |
| Last Update Date | 09/18/2012 |
| Medicare PECOS PAC ID | 2668713512 |
|---|---|
| Medicare Enrollment ID | O20190403000987 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255681128 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Toni Roussel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720012859 PECOS PAC ID: 8325072242 Enrollment ID: I20050921000037 |
| Provider Name | Khrishandalyn Rationne Hicks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821464546 PECOS PAC ID: 7810238763 Enrollment ID: I20190403001093 |
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