Healthcare Provider Details

I. General information

NPI: 1669166344
Provider Name (Legal Business Name): LIGHTHOUSE COUNSELING AND FAMILY RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 SUNRISE AVE STE 110
ROSEVILLE CA
95661-4596
US

IV. Provider business mailing address

110 GATEWAY DR STE 210
LINCOLN CA
95648-3306
US

V. Phone/Fax

Practice location:
  • Phone: 916-645-3300
  • Fax:
Mailing address:
  • Phone: 530-312-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: RICARDO LOPEZ
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 530-312-1234