Organization · Type 2 NPI
Light House Group Home LLC
Substance Use Disorder Rehabilitation Clinic/Center · Mesa, AZ
NPI number
1154940864
Active
Practice location
108 E 2nd Ave Ste 101
Mesa, AZ 85210-1410
Mailing address
108 E 2nd Ave
Mesa, AZ 85210-1410
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center Primary | 261QR0405X | None listed |
Substance Use Disorder Rehabilitation Clinic/Center: Definition to come...
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About NPI 1154940864
Light House Group Home LLC's National Provider Identifier is 1154940864, issued on Apr 13, 2020. The primary taxonomy on file is Substance Use Disorder Rehabilitation Clinic/Center (261QR0405X), and the practice location is in Mesa, AZ. The record was last updated on Apr 13, 2020.