Active NPI
Lighthouse Recovery
- Addiction Medicine (Preventive Medicine) Physician
- St Charles, IL
National Provider Identifier
1063373835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Preventive Medicine) Physician
- Legal business name
- LIGHTHOUSE RECOVERY
- Practice address
- 210 S 5TH St Ste 10
St Charles, IL 60174-2700 - Phone
- (630) 677-5982
- NPI assigned
- Nov 20, 2025
- Organization subpart
- Yes
- Parent organization
- LIGHTHOUSE RECOVERY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Martin Keifer
- Title
- Owner
- Phone
- (630) 940-2468
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Preventive Medicine) Physician | 2083A0300X | Primary |
Addresses
Primary practice location
210 S 5TH St Ste 10
St Charles, IL 60174-2700
Mailing address
210 S 5TH St Ste 10
St Charles, IL 60174-2700
Phone (630) 940-2468
National Provider Directory
National Provider Directory- Tax ID family
- Lighthouse Recovery
- Part of
- Lighthouse Recovery
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- St Charles, IL
- NPI 1700246139
Locations
210 S 5th St
Ste 10
St Charles, IL 60174
Phone (630) 677-5982
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- St Charles, IL
- NPI 1700246139
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Professional Counselor
- Wheaton, IL
- NPI 1720257694
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763596800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1764633600000",
"number": "1063373835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S 5TH ST STE 10",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601742700",
"telephone_number": "630-940-2468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 S 5TH ST STE 10",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601742700",
"telephone_number": "630-677-5982"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIGHTHOUSE RECOVERY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LIGHTHOUSE RECOVERY",
"enumeration_date": "2025-11-20",
"last_updated": "2025-12-02",
"certification_date": "2025-12-02",
"status": "A",
"authorized_official_last_name": "KEIFER",
"authorized_official_first_name": "MARTIN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "630-940-2468"
},
"taxonomies": [
{
"code": "2083A0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Preventive Medicine, Addiction Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.