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General NPI Number Information
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NPI Number | 1538004338
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE VISIONARY GROUP
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 5621 PALM AVE
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City | SACRAMENTO
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State | CA
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Zip | 95841-2919
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Country | US
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Telephone | 916-735-6128
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Fax | 916-735-6128
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Provider Business Mailing Address
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Address Line | 5621 PALM AVE
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City | SACRAMENTO
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State | CA
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Zip | 95841-2919
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Country | US
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Telephone | 916-735-6128
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Fax | 916-735-6128
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | STACEY MCELHENY
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Credential | MCELHENY
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Telephone | 916-342-2753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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