Provider Demographics
NPI:1578922217
Name:THE LIGHT HOUSE GROUP LIVING LLC
Entity Type:Organization
Organization Name:THE LIGHT HOUSE GROUP LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ARCHIE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:281-635-0183
Mailing Address - Street 1:22307 SPRING CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-5070
Mailing Address - Country:US
Mailing Address - Phone:281-635-0183
Mailing Address - Fax:832-823-0156
Practice Address - Street 1:9330 W MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-4702
Practice Address - Country:US
Practice Address - Phone:281-635-0183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility