Organization
LIGHTHOUSE CREW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM ESCHBACH (PRESIDENT)
(954) 522-5003
Entity
Organization
Contact information
Practice address
417 SW 12TH ST, FORT LAUDERDALE, FL 33315-1406
(954) 522-5003
Mailing address
757 SE 17TH ST # 811, FORT LAUDERDALE, FL 33316-2960
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
09/17/2014
Last updated
09/17/2014
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