NPIMap

Organization Active NPI

Light House Group Home LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Mesa, AZ
National Provider Identifier
1154940864
Registry record updated Apr 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
LIGHT HOUSE GROUP HOME LLC
Practice address
108 E 2ND Ave Ste 101
Mesa, AZ 85210-1410
Phone
(480) 200-1437
NPI assigned
Apr 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeff Presutti
Title
Owner/Ceo
Phone
(480) 332-0385

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

108 E 2ND Ave Ste 101
Mesa, AZ 85210-1410

Mailing address

108 E 2ND Ave
Mesa, AZ 85210-1410

Other names 1

  • Nova108 Outpatient Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Light House Group Home LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

108 E 2nd Ave
Ste 101
Mesa, AZ 85210
Phone (480) 200-1437

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586736000000",
    "number": "1154940864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 E 2ND AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852101410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 E 2ND AVE STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852101410",
            "telephone_number": "480-200-1437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHT HOUSE GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-13",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A",
        "authorized_official_last_name": "PRESUTTI",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "480-332-0385"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nova108 Outpatient",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.