Provider Demographics
NPI:1235821083
Name:LIGHTHOUSE SOBER SOLUTIONS LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE SOBER SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:METCALFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-370-7573
Mailing Address - Street 1:202 BISHOP LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9266
Mailing Address - Country:US
Mailing Address - Phone:270-234-0003
Mailing Address - Fax:270-360-0840
Practice Address - Street 1:202 BISHOP LN
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9266
Practice Address - Country:US
Practice Address - Phone:270-234-0003
Practice Address - Fax:270-360-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health