# THE LIGHTHOUSE - TRAVERSE CITY, LLC

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

## Provider details

- **NPI number:** 1740369446
- **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, 1655 E CARO RD, CARO, MI 48723-0289
- **Mailing address phone:** (989) 673-2500
- **Mailing address fax:** (989) 673-3356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/03/2006
- **Last updated:** 08/22/2020