Provider Demographics
NPI:1427456458
Name:THE COMMUNITY LIGHTHOUSE
Entity type:Organization
Organization Name:THE COMMUNITY LIGHTHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-273-6300
Mailing Address - Street 1:3301 CANDELARIA RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1965
Mailing Address - Country:US
Mailing Address - Phone:505-273-6300
Mailing Address - Fax:505-265-7860
Practice Address - Street 1:3301 CANDELARIA RD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1965
Practice Address - Country:US
Practice Address - Phone:505-273-6300
Practice Address - Fax:505-265-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM08822104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty