Provider Demographics
NPI:1912294349
Name:MI-WIN, INC.
Entity Type:Organization
Organization Name:MI-WIN, INC.
Other - Org Name:DBA JUSTIN'S LIGHTHOUSE RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-919-8781
Mailing Address - Street 1:5425 S LAKEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7742
Mailing Address - Country:US
Mailing Address - Phone:405-919-8781
Mailing Address - Fax:
Practice Address - Street 1:5425 S LAKEWOOD PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7742
Practice Address - Country:US
Practice Address - Phone:405-919-8781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health