LIGHTHOUSE RECOVERY NPI 1700246139

NPI Information

NPI: 1700246139
Provider Name: LIGHTHOUSE RECOVERY
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 14D2130189

Address:
210 S 5TH ST
SUITE 10
ST CHARLES, IL
ZIP 60174
Phone: (630) 940-2468
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LIGHTHOUSE RECOVERY is a rehabilitation and substance use disorder clinic center in St Charles, IL. LIGHTHOUSE RECOVERY NPI is 1700246139. The provider is registered as an organization entity type.

The provider's business location address is:

210 S 5TH ST
SUITE 10
ST CHARLES, IL
ZIP 60174-764
Phone: (630) 940-2468

The provider's authorized official is Martin Keifer .
The authorized official title is President and has the following contact phone number (630) 940-2468.

The CLIA number assigned to this NPI record is 14D2130189 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/26/2016 and was last updated on 3/25/2024.

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	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	A-6255-0001-A	ILLINOIS	Yes

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: 5/5/2024

NPI Synchronization or Removal

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