Provider Demographics
NPI:1144214354
Name:LIGHTHOUSE CENTER INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE CENTER INC.
Other - Org Name:SABRA HOUSE DBA THE LIGHTHOUSE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CEO AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SABRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-451-0819
Mailing Address - Street 1:10752 N 89TH PL
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6730
Mailing Address - Country:US
Mailing Address - Phone:480-451-0819
Mailing Address - Fax:480-860-2522
Practice Address - Street 1:10752 N 89TH PL
Practice Address - Street 2:SUITE 113
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6730
Practice Address - Country:US
Practice Address - Phone:480-451-0819
Practice Address - Fax:480-860-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-01701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZCSW170IMedicare PIN
AZR19182Medicare UPIN