- Enrollment id
- O20120824000453
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1215297478
- Multiple npi flag
- N
- Ccn
- 059590
- Associate id
- 1456508571
- Organization name
- LIGHTHOUSE HOME HEALTH CARE, INC.
- Incorporation date
- 2012-04-16
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5500 MING AVE
- Address line 2
- STE 180
- City
- BAKERSFIELD
- State
- CA
- Zip code
- 933094623