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Organization

LIGHT HOUSE GROUP HOME LLC

Active
Other names
Nova108 Outpatient
Organization subpart
No

Provider details

NPI number
Authorized official
JEFF PRESUTTI (OWNER/CEO)
(480) 332-0385
Entity
Organization

Contact information

Practice address
108 E 2ND AVE STE 101, MESA, AZ 85210-1410
(480) 200-1437
Mailing address
108 E 2ND AVE, MESA, AZ 85210-1410

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Enumeration date
04/13/2020
Last updated
04/13/2020
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