Provider Demographics
NPI:1013244797
Name:THE NORTHERN LIGHTHOUSE INC
Entity Type:Organization
Organization Name:THE NORTHERN LIGHTHOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-425-3880
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:
Mailing Address - Fax:
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:207-425-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities