14D2130189 CLIA NUMBER - LIGHTHOUSE RECOVERY INC

Laboratory Demographics

CLIA Number: 14D2130189

Facility Name: LIGHTHOUSE RECOVERY INC

Facility Address:
210 S 5TH ST, SUITE 10
SAINT CHARLES, IL
ZIP 60174
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Facility Phone Number: 630 940-2468

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1700246139

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2130189
LAB Type	Practitioner Other
Facility Name	LIGHTHOUSE RECOVERY INC
Street	210 S 5TH ST, SUITE 10
City	SAINT CHARLES
State	IL
ZIP	60174
Phone	630 940-2468
CertificateType	4
CertificateEffectiveDate	5/3/2023
CertificateExpirationDate	5/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024