Healthcare Provider Details

I. General information

NPI: 1427277946
Provider Name (Legal Business Name): LIGHTHOUSE CMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 NW 7TH ST
MIAMI FL
33125-3502
US

IV. Provider business mailing address

1704 NW 7TH ST
MIAMI FL
33125-3502
US

V. Phone/Fax

Practice location:
  • Phone: 305-541-2600
  • Fax: 305-541-2222
Mailing address:
  • Phone: 305-541-2600
  • Fax: 305-541-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL A MENDOZA
Title or Position: CEO
Credential:
Phone: 305-541-2600