Organization
THE LIGHTHOUSE - TRAVERSE CITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WILSON (DIRECTOR OF FINANCE)
(989) 673-2500
Entity
Organization
Contact information
Practice address
4140 BEACON ST, KINGSLEY, MI 49649
(231) 263-1350
(231) 263-1353
Mailing address
PO BOX 289, CARO, MI 48723-0289
(989) 673-2500
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/03/2006
Last updated
01/28/2013
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