Healthcare Provider Details

I. General information

NPI: 1437614583
Provider Name (Legal Business Name): LIGHTHOUSE BEHAVIORAL HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E MONUMENT ST
BALTIMORE MD
21202-4119
US

IV. Provider business mailing address

3310 EASTERN AVE
BALTIMORE MD
21224-4108
US

V. Phone/Fax

Practice location:
  • Phone: 443-705-5056
  • Fax:
Mailing address:
  • Phone: 667-400-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: VERNON HOLMES
Title or Position: CEO
Credential:
Phone: 667-400-6206