Organization
LIGHTHOUSE HOSPICE OF ALABAMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS PAUL OUTLAW (CEO)
(334) 566-4357
Entity
Organization
Contact information
Practice address
413 S BRUNDIDGE ST, SUITE B, TROY, AL 36081-3331
(334) 566-4357
(334) 566-2220
Mailing address
PO BOX 965, TROY, AL 36081-0965
(334) 566-4357
(334) 566-2220
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
11735
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013221
BCBS OF AL PROVIDER #
AL
05
—
PIC1636E
—
AL
Enumeration date
09/25/2006
Last updated
08/22/2020
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