Provider Demographics
NPI:1154531853
Name:THE LIGHTHOUSE ADDICTION RECOVERY CENTRE
Entity type:Organization
Organization Name:THE LIGHTHOUSE ADDICTION RECOVERY CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-543-9061
Mailing Address - Street 1:374 H STREET
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4109
Mailing Address - Country:US
Mailing Address - Phone:360-543-5339
Mailing Address - Fax:360-543-5339
Practice Address - Street 1:374 H ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4109
Practice Address - Country:US
Practice Address - Phone:360-543-5339
Practice Address - Fax:360-543-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA37131800324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility