Provider Demographics
NPI:1063373835
Name:LIGHTHOUSE RECOVERY
Entity type:Organization
Organization Name:LIGHTHOUSE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-940-2468
Mailing Address - Street 1:210 S 5TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2700
Mailing Address - Country:US
Mailing Address - Phone:630-940-2468
Mailing Address - Fax:
Practice Address - Street 1:210 S 5TH ST STE 10
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2700
Practice Address - Country:US
Practice Address - Phone:630-677-5982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-20
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty