NPIMap

Organization Active NPI

The Lighthouse - Traverse City, LLC

  • Rehabilitation Clinic/Center
  • Kingsley, MI
National Provider Identifier
1740369446
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
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

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

4140 Beacon St
Kingsley, MI 49649

Mailing address

PO Box 289
1655 E Caro Rd
Caro, MI 48723-0289
Phone (989) 673-2500

National Provider Directory

National Provider Directory
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.

Locations

4140 Beacon St
Kingsley, MI 49649
Phone (231) 263-1350

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740369446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 289",
            "address_2": "1655 E CARO RD",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487230289",
            "telephone_number": "989-673-2500",
            "fax_number": "989-673-3356"
        },
        {
            "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": "2020-08-22",
        "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": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsley, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.