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General NPI Number Information
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NPI Number | 1053232108
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE RECOVERY RESIDENCES, LLC
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 120 S MANTLE AVE
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-1606
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Country | US
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Telephone | 502-417-9675
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Fax | 270-360-0840
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Provider Business Mailing Address
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Address Line | 120 S MANTLE AVE
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-1606
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Country | US
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Telephone | 502-417-9675
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Fax | 270-360-0840
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA METCALFE
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Credential |
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Telephone | 270-234-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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