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Organization
LP LIGHTHOUSE LLC
Active
Organization
LP LIGHTHOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY D PRUITT (OWNER)
(248) 234-8533
Entity
Organization
Contact information
Practice address
25820 SOUTHFIELD RD STE 202, SOUTHFIELD, MI 48075-1828
(248) 234-8533
(248) 234-8533
Mailing address
25820 SOUTHFIELD RD STE 202, SOUTHFIELD, MI 48075-1828
(248) 234-8533
(248) 234-8533
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
MI
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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