| Lighthouse Family Residential Llc | |
|
17524 N Rosa Dr Maricopa AZ 85138-1840 | |
| (480) 238-2909 | |
| Not Available |
| Full Name | Lighthouse Family Residential Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 17524 N Rosa Dr, Maricopa, Arizona |
| Authorized Official Name and Position | Ebenezer Ofori (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 4802382909 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Family Residential Llc 17524 N Rosa Dr Maricopa AZ 85138-1840 Ph: (480) 238-2909 | Lighthouse Family Residential Llc 17524 N Rosa Dr Maricopa AZ 85138-1840 Ph: (480) 238-2909 |
| NPI Number | 1790531481 |
|---|---|
| Provider Enumeration Date | 04/24/2024 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790531481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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