Provider Demographics
NPI:1720234396
Name:THE LIGHTHOUSE OF TALLAPOOSA CO. INC.
Entity Type:Organization
Organization Name:THE LIGHTHOUSE OF TALLAPOOSA CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:256-234-4894
Mailing Address - Street 1:36 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-1913
Mailing Address - Country:US
Mailing Address - Phone:256-234-4894
Mailing Address - Fax:256-234-4854
Practice Address - Street 1:36 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-1913
Practice Address - Country:US
Practice Address - Phone:256-234-4894
Practice Address - Fax:256-234-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility