# LIGHTHOUSE COMMUNITY OUTREACH, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053546093
- **Authorized official:** MS. SHELLY KAY BYNUM (EXECUTUVE DIRECTOR)
- **Authorized official phone:** (323) 401-7600

## Contact information

- **Practice address:** 1968 E 103RD ST, LOS ANGELES, CA 90002-3124
- **Practice address phone:** (323) 567-2285
- **Practice address fax:** (323) 567-2622
- **Mailing address:** 1976 E 103RD ST, LOS ANGELES, CA 90002-3124
- **Mailing address phone:** (323) 567-2285
- **Mailing address fax:** (323) 567-2622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | CA | Yes |

## Other

- **Enumeration date:** 05/20/2009
- **Last updated:** 05/20/2009