Healthcare Provider Details

I. General information

NPI: 1346623659
Provider Name (Legal Business Name): GARNER LIGHTHOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 BENSON RD
GARNER NC
27529-3988
US

IV. Provider business mailing address

607 BENSON RD
GARNER NC
27529-3988
US

V. Phone/Fax

Practice location:
  • Phone: 919-594-1354
  • Fax: 919-594-1369
Mailing address:
  • Phone: 919-594-1354
  • Fax: 919-594-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number29910
License Number StateNC

VIII. Authorized Official

Name: MR. RICHARD HENRY FLEMING
Title or Position: DIRECTOR
Credential:
Phone: 919-422-3663