Provider Demographics
NPI:1326879990
Name:LIGHTHOUSE TREATMENT CENTERS OF GEORGIA LLC
Entity type:Organization
Organization Name:LIGHTHOUSE TREATMENT CENTERS OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOUHICHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-486-7782
Mailing Address - Street 1:37 KIKER ST
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3758
Mailing Address - Country:US
Mailing Address - Phone:706-636-5483
Mailing Address - Fax:706-636-5495
Practice Address - Street 1:37 KIKER ST
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3758
Practice Address - Country:US
Practice Address - Phone:706-636-5483
Practice Address - Fax:706-636-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility