# THE LIGHTHOUSE - TRAVERSE CITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649359316
- **Authorized official:** MARK WILSON (DIRECTOR OF FINANCE)
- **Authorized official phone:** (989) 673-2500

## Contact information

- **Practice address:** 4140 BEACON ST, KINGSLEY, MI 49649
- **Practice address phone:** (231) 263-1350
- **Practice address fax:** (231) 263-1353
- **Mailing address:** PO BOX 289, CARO, MI 48723-0289
- **Mailing address phone:** (989) 673-2500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311Z00000X | Custodial Care Facility | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | — |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/03/2006
- **Last updated:** 01/28/2013