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Organization
LIGHTHOUSE OF JACKSON LLC
Active
Organization
LIGHTHOUSE OF JACKSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN FLOWERS (MEMBER, CFO)
(517) 240-9329
Entity
Organization
Contact information
Practice address
228 E MAIN ST, SPRING ARBOR, MI 49283-9673
(517) 240-9329
Mailing address
2548 S SANDSTONE RD, JACKSON, MI 49201-9374
(517) 240-9329
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
Other
Enumeration date
06/26/2021
Last updated
07/07/2021
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