The Lighthouse - Traverse City, LLC

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

Legal business name

THE LIGHTHOUSE - TRAVERSE CITY, LLC

Practice address

4140 Beacon St
Kingsley, MI 49649

Phone

(231) 263-1350

Fax

(231) 263-1353

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Authorized official

Name

Mark Wilson

Title

Director of Finance

Phone

(989) 673-2500

Specialties & licenses 3

Addresses

Tax ID family

The Lighthouse - Traverse City 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.

• The Lighthouse - Traverse City, LLC

  • Rehabilitation Clinic/Center
  • Kingsley, MI
  • NPI 1740369446
  NPD tax ID

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1649359316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 289",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487230289",
            "telephone_number": "989-673-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4140 BEACON ST",
            "city": "KINGSLEY",
            "state": "MI",
            "postal_code": "49649",
            "telephone_number": "231-263-1350",
            "fax_number": "231-263-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIGHTHOUSE - TRAVERSE CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "989-673-2500"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Elaine Smith, PHARMD
• Kari Jo Speckman, MS PT CMLDT
• Jessica Jolene Stark, CTRS
• Terrence A Stevens
• Jenna Lynn Stump, PA
• The Lighthouse - Traverse City, LLC
• Amy Elizabeth Thomas, MSW.LMSW
• Crystal M Thomas, LMSW
• Township of Paradise
• Alyssa Treacy

• Physical Disabilities Residential Treatment Facility in Kingsley, MI
• Providers in Kingsley, MI by specialty
• Physical Disabilities Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; 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.