Light House Group Home LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

LIGHT HOUSE GROUP HOME LLC

Practice address

108 E 2ND Ave
Mesa, AZ 85210-1410

Phone

(480) 332-0385

NPI assigned

May 31, 2019

Last updated

May 31, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeff Presutti

Title

Ceo

Phone

(480) 332-0385

Specialties & licenses 1

Addresses

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.

• Light House Group Home LLC

  dba Nova108 Outpatient

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Mesa, AZ
  • NPI 1154940864
  NPD tax ID

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559260800000",
    "number": "1316505753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9713 E EL PASO ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852075351",
            "telephone_number": "480-332-0385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 E 2ND AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852101410",
            "telephone_number": "480-332-0385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHT HOUSE GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-31",
        "last_updated": "2019-05-31",
        "status": "A",
        "authorized_official_last_name": "PRESUTTI",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-332-0385"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifewell Behavioral Wellness
• Lifewell Behavioral Wellness
• Lifewell Behavioral Wellness
• Casandra Ann Liggins, MD
• Light House Group Home LLC (Nova108 Outpatient)
• Light Touch Laser and Dental Implant Center, PLLC (Light Touch Dental Laser and Implant Center)
• Lighthouse Support Services LLC
• Lighthouse Support Services LLC
• Daisy Hannah Liljenquist, PA
• Loren Edgar Lilly, RRT

• Substance Abuse Rehabilitation Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; 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.