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General NPI Number Information
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NPI Number | 1265862973
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE ICF/DDN
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 17001 SAGA DR
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City | YORBA LINDA
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State | CA
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Zip | 92886-3627
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Country | US
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Telephone | 714-223-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 5025 MARSHBURN CIR
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City | YORBA LINDA
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State | CA
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Zip | 92886-3926
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Country | US
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Telephone | 714-335-9305
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | RENEE BROWN
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Credential |
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Telephone | 714-335-9305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | CA
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