NPIMap

Organization Active NPI

The Lighthouse Mentoring Center

  • Mental Illness Community Based Residential Treatment Facility
  • Antioch, CA
National Provider Identifier
1891361119
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
THE LIGHTHOUSE MENTORING CENTER
Practice address
1925 Garden CT
Antioch, CA 94509-2865
Phone
(925) 778-4749
Fax
(925) 267-2578
NPI assigned
May 27, 2021
Organization subpart
Yes
Parent organization
THE LIGHTHOUSE MENTORING CENTER 1As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Authorized official

Name
Quimani Green, LCSW
Title
Head of Service
Phone
(925) 778-4749

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

1925 Garden CT
Antioch, CA 94509-2865

Mailing address

PO Box 853
Pittsburg, CA 94565-0085
Phone (925) 628-1641

Other names 1

  • The Lighthouse Mentoring Center 1 Other name

National Provider Directory

National Provider Directory
Tax ID family
The Lighthouse Mentoring Center6 organizations share this tax ID, including this one
Part of
The Lighthouse Mentoring Center

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1891361119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 853",
            "city": "PITTSBURG",
            "state": "CA",
            "postal_code": "945650085",
            "telephone_number": "925-628-1641",
            "fax_number": "925-267-2578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 GARDEN CT",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945092865",
            "telephone_number": "925-778-4749",
            "fax_number": "925-267-2578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIGHTHOUSE MENTORING CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE LIGHTHOUSE MENTORING CENTER 1",
        "enumeration_date": "2021-05-27",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "QUIMANI",
        "authorized_official_title_or_position": "HEAD OF SERVICE",
        "authorized_official_telephone_number": "925-778-4749",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lighthouse Mentoring Center 1",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Antioch, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.