NPIMap

Organization Active NPI

Lighthouse Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • St Charles, IL
National Provider Identifier
1700246139
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
A-6255-0001-A Issued in IL
Legal business name
LIGHTHOUSE RECOVERY
Practice address
210 S 5TH St
Suite 10
St Charles, IL 60174-2764
Phone
(630) 940-2468
NPI assigned
Feb 26, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Authorized official

Name
Martin Keifer
Title
President
Phone
(630) 940-2468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X A-6255-0001-A IL Primary

Addresses

Primary practice location

210 S 5TH St
Suite 10
St Charles, IL 60174-2764

Mailing address

210 S 5TH St
Suite 10
St Charles, IL 60174-2764
Phone (630) 940-2468

Other practice location 1

37W755 Route Il-38
Suite 10
St. Charles, IL 60175
Phone (630) 669-3354

Other practice location 2

308 Walnut St Ste 10
St Charles, IL 60174-2725
Phone (630) 940-2468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240508003027 IL Part B Supplier - Clinic/Group Practice 6305287343 Receives reassigned benefits from 3 practitioners
Practice locations: St Charles, IL

National Provider Directory

National Provider Directory
Tax ID family
Lighthouse Recovery2 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

37W755 Il Route 38
Ste 10
St Charles, IL 60175
Phone (630) 669-3354

308 Walnut St
St Charles, IL 60174
Phone (630) 940-2468

37W755 Il Route 38
St Charles, IL 60175
Phone (630) 208-2173

308 Walnut St
Ste 10
St Charles, IL 60174
Phone (630) 940-2468

210 S 5th St
St Charles, IL 60174

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1700246139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S 5TH ST",
            "address_2": "SUITE 10",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742764",
            "telephone_number": "630-940-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S 5TH ST",
            "address_2": "SUITE 10",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742764",
            "telephone_number": "630-940-2468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37W755 ROUTE IL-38",
            "address_2": "Suite 10",
            "address_purpose": "LOCATION",
            "city": "St. Charles",
            "state": "IL",
            "postal_code": "60175",
            "country_code": "US",
            "telephone_number": "630-669-3354",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "308 Walnut St Ste 10",
            "address_purpose": "LOCATION",
            "city": "St Charles",
            "state": "IL",
            "postal_code": "601742725",
            "country_code": "US",
            "telephone_number": "630-940-2468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIGHTHOUSE RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-26",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "KEIFER",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-940-2468"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IL",
            "license": "A-6255-0001-A",
            "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 Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.