Provider Demographics
NPI:1831311968
Name:NORTHERN LIGHTHOUSE INC.
Entity Type:Organization
Organization Name:NORTHERN LIGHTHOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CRAY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:207-554-5114
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-0498
Mailing Address - Country:US
Mailing Address - Phone:207-425-3880
Mailing Address - Fax:207-425-9048
Practice Address - Street 1:14 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758
Practice Address - Country:US
Practice Address - Phone:207-425-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251S00000X, 320900000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135580000Medicaid
ME432482300Medicaid
ME1355800001Medicaid
ME135580100Medicaid