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General NPI Number Information
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NPI Number | 1154531853
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Entity Type | Organization
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Legal Business Name | THE LIGHTHOUSE ADDICTION RECOVERY CENTRE
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 374 H ST
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City | BLAINE
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State | WA
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Zip | 98230-4109
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Country | US
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Telephone | 360-543-5339
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Fax | 360-543-5339
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Provider Business Mailing Address
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Address Line | 374 H STREET
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City | BLAINE
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State | WA
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Zip | 98230-4109
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Country | US
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Telephone | 360-543-5339
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Fax | 360-543-5339
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | JOYCE A BIGELOW
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Credential |
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Telephone | 360-543-9061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 37131800
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License Number State | WA
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