Organization
LIGHTHOUSE RESIDENTIAL HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT EARL OWENS JR. (PRESIDENT)
(804) 337-1403
Entity
Organization
Contact information
Practice address
5219 SUMMERLEAF DR, NORTH CHESTERFIELD, VA 23234-2817
(804) 337-1403
(804) 590-2763
Mailing address
13518 MARSH ELDER CT, CHESTERFIELD, VA 23838-3406
(804) 337-1403
(804) 590-2763
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/23/2020
Last updated
04/09/2020
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