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General NPI Number Information
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NPI Number | 1396549762
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE RECOVERY CENTERS LLC
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 18663 VENTURA BLVD STE 210
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City | TARZANA
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State | CA
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Zip | 91356-4195
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Country | US
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Telephone | 818-794-7321
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Fax |
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Provider Business Mailing Address
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Address Line | 18663 VENTURA BLVD STE 210
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City | TARZANA
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State | CA
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Zip | 91356-4195
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | AARON BARSALOU
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Credential |
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Telephone | 818-489-4592
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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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