Healthcare Provider Details

I. General information

NPI: 1467947218
Provider Name (Legal Business Name): LIGHTHOUSE RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11191 E HARVARD DR
AURORA CO
80014-1708
US

IV. Provider business mailing address

6630 E HAMPDEN AVENUE
DENVER CO
80224-3004
US

V. Phone/Fax

Practice location:
  • Phone: 303-368-0777
  • Fax: 303-484-4024
Mailing address:
  • Phone: 720-934-6070
  • Fax: 303-484-4024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD RUVINS
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 720-934-1122