Organization
LIGHTHOUSE SUPPORTIVE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAQUASHA L MCMILLAN JOHNSON (OWNER)
(201) 238-1799
Entity
Organization
Contact information
Practice address
758 OCEAN AVE, JERSEY CITY, NJ 07304-2725
(201) 238-1799
Mailing address
34 SQUIRE HILL RD, LONG VALLEY, NJ 07853-3223
(201) 238-1799
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/11/2025
Last updated
12/11/2025
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