Organization
LIGHTHOUSE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN KEIFER (PRESIDENT)
(630) 940-2468
Entity
Organization
Contact information
Practice address
210 S 5TH ST, SUITE 10, ST CHARLES, IL 60174-2764
(630) 940-2468
Mailing address
210 S 5TH ST, SUITE 10, ST CHARLES, IL 60174-2764
(630) 940-2468
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-6255-0001-A
IL
Other
Enumeration date
02/26/2016
Last updated
11/01/2024
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