Provider Demographics
NPI:1437635141
Name:LIGHTHOUSE COMMUNITY INVESTMENT AGENCY INC
Entity Type:Organization
Organization Name:LIGHTHOUSE COMMUNITY INVESTMENT AGENCY INC
Other - Org Name:LIGHTHOUSE RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-475-4663
Mailing Address - Street 1:102 PRICHARD STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 PRICHARD STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-475-4663
Practice Address - Fax:304-475-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder