Provider Demographics
NPI:1386315091
Name:JC LIGHTHOUSE
Entity type:Organization
Organization Name:JC LIGHTHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-825-7500
Mailing Address - Street 1:6490 S. MCCARRAN BLVD
Mailing Address - Street 2:BUILDING C UNIT 21
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-825-7500
Mailing Address - Fax:
Practice Address - Street 1:6490 S. MCCARRAN BLVD
Practice Address - Street 2:BUILDING C UNIT 21
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-825-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JC LIGHTHOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness