Provider Demographics
NPI:1770047565
Name:LIGHTHOUSE RECOVERY CENTER, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE RECOVERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-698-7631
Mailing Address - Street 1:311 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-2915
Mailing Address - Country:US
Mailing Address - Phone:812-698-7631
Mailing Address - Fax:812-257-8825
Practice Address - Street 1:311 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2915
Practice Address - Country:US
Practice Address - Phone:812-698-7631
Practice Address - Fax:812-257-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility