Provider Demographics
NPI:1275118333
Name:LIGHTHOUSE RECOVERY SERVICES LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-447-3582
Mailing Address - Street 1:6630 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3004
Mailing Address - Country:US
Mailing Address - Phone:720-934-6070
Mailing Address - Fax:303-484-4024
Practice Address - Street 1:6630 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3004
Practice Address - Country:US
Practice Address - Phone:855-415-0034
Practice Address - Fax:303-484-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility