# LIGHTHOUSE RESIDENITAL

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

## Provider details

- **NPI number:** 1710483714
- **Authorized official:** TERESA HORNBUCKLE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (720) 465-0920

## Contact information

- **Practice address:** 10200 W 44TH AVE STE 400B, WHEAT RIDGE, CO 80033-6826
- **Practice address phone:** (720) 465-0920
- **Practice address fax:** (303) 337-0038
- **Mailing address:** 10200 W 44TH AVE STE 400B, WHEAT RIDGE, CO 80033-6826
- **Mailing address phone:** (720) 465-0920
- **Mailing address fax:** (303) 337-0038

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/30/2018
- **Last updated:** 03/30/2018