1467947218 NPI number — LIGHTHOUSE RECOVERY SERVICES LLC

Table of content: (NPI 1467947218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467947218 NPI number — LIGHTHOUSE RECOVERY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIGHTHOUSE RECOVERY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIGHTHOUSE RECOVERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467947218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6630 E HAMPDEN AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80224-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-934-6070
Provider Business Mailing Address Fax Number:
303-484-4024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11191 E HARVARD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-368-0777
Provider Business Practice Location Address Fax Number:
303-484-4024
Provider Enumeration Date:
06/25/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUVINS
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
720-934-1122

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)