Healthcare Provider Details

I. General information

NPI: 1326977521
Provider Name (Legal Business Name): LIGHTHOUSE TREATMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 ROSECRANS ST
SAN DIEGO CA
92110-3116
US

IV. Provider business mailing address

30211 AVENIDA DE LAS BANDERA STE 200 (619) 515-0243
RANCHO SANTA MARGARITA CA
92688-2159
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-0243
  • Fax:
Mailing address:
  • Phone: 619-515-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TYLER COLLINS
Title or Position: CEO
Credential:
Phone: 619-515-0243