LIGHT HOUSE GROUP NPI 1225166069

NPI Information

NPI: 1225166069
Provider Name: LIGHT HOUSE GROUP
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address: 206 WAPITI DR
108 ASHTON PL
SPRING LAKE, NC
ZIP 28390
Phone: (910) 497-0299

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NPI Details

LIGHT HOUSE GROUP is a residential treatment facility emotionally disturbed children in Spring Lake, NC. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. LIGHT HOUSE GROUP NPI is 1225166069. The provider is registered as an organization entity type.

The provider's business location address is:

206 WAPITI DR
108 ASHTON PL
SPRING LAKE, NC
ZIP 28390-530
Phone: (910) 497-0299
Fax: (910) 497-0297

The provider's authorized official is Charles Davenport .
The authorized official title is President and has the following contact phone number (910) 497-0299.

The enumeration date for this NPI number is 3/2/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	MHL -026-805	NORTH CAROLINA	No
2	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	MHL-026-782	NORTH CAROLINA	No
3	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	MHL-026-627	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	6603652	MEDICAID	NORTH CAROLINA
2	6603194	MEDICAID	NORTH CAROLINA
3	6603907	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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