THE LIGHTHOUSE - TRAVERSE CITY, LLC (NPI# 1649359316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649359316 |
| Entity Type | Organization |
| Organization Name | THE LIGHTHOUSE - TRAVERSE CITY, LLC |
| Practice Address |
4140 Beacon St Kingsley MI 49649 |
| Mailing Address |
Po Box 289 Caro MI 48723-0289 |
| Practice Telephone | 2312631350 |
| Practice Fax Number | 2312631353 |
| Mailing Telephone | 9896732500 |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2013-01-28 |
| Authorized Official Name | MARK WILSON (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 9896732500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311Z00000X | Custodial Care Facility | Nursing & Custodial Care Facilities | ||
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740369446 | The Lighthouse - Traverse City, LLC | Clinic/Center | 4140 Beacon St, Kingsley, MI 49649 | 2006-11-03 |
| Street Address |
4140 BEACON ST |
| City | KINGSLEY |
| State | MI |
| Zip Code | 49649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740369446 | The Lighthouse - Traverse City, LLC | Clinic/Center | 4140 Beacon St, Kingsley, MI 49649 | 2006-11-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346742053 | Carlene Brown | Physical Therapist | 850 Brewster Trl, Kingsley, MI 49649 | 2018-03-08 |
| 1063926756 | Cheryl Sue Dann | Social Worker | 2283 M-113 E, Kingsley, MI 49649 | 2017-11-17 |
| 1386168854 | Lori Rachelle Metcalf-rodes | Counselor | 5081 Walton Road, Kingsley, MI 49649 | 2017-07-27 |
| 1356891865 | David Erik Richard Burke | Dentist | 116 W Main St., Kingsley, MI 49649 | 2016-10-07 |
| 1366766081 | Kimberly Anne Michels | Nurse Practitioner | 112 S. Brownson Ave, Kingsley, MI 49649 | 2010-03-24 |
| 1528382538 | Grand Traverse County Health Department | Clinic/Center | 112 S Brownson Ave, Kingsley, MI 49649 | 2010-03-19 |
| 1477739571 | Rnc Medical Supplies | Durable Medical Equipment & Medical Supplies | 9437 Church St, Kingsley, MI 49649 | 2008-01-18 |
| 1568842052 | Anna Cox | Registered Nurse | 2283 E M 113, Kingsley, MI 49649 | 2015-06-01 |
| 1558381509 | Michael Zaleski | Pharmacist | 114 S. Brownson Ave, Kingsley, MI 49649-0247 | 2006-07-20 |
| 1225058449 | Kingsley Pharmaceuticals Inc. | Durable Medical Equipment & Medical Supplies | 118 S Brownson Ave, Kingsley, MI 49649-0367 | 2006-07-20 |
| Find all providers in zip 49649 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083173017 | Newport Care Center | Residential Treatment Facility, Physical Disabilities | 22977 Newport St, Southfield, MI 48075-5850 | 2019-03-19 |
| 1104352285 | Tukeisha Snedecar | Residential Treatment Facility, Physical Disabilities | 19210 Conley St, Detroit, MI 48234-2276 | 2017-05-10 |
| 1760925556 | Connect Care Network Inc. | Residential Treatment Facility, Physical Disabilities | 19761 Annott St, Detroit, MI 48205-1603 | 2016-11-28 |
| 1750832564 | First Door, LLC | Residential Treatment Facility, Physical Disabilities | 25584 W 10 Mile Rd, Southfield, MI 48033-4826 | 2016-10-17 |
| 1306390737 | Nikeyla Blakeney | Residential Treatment Facility, Physical Disabilities | 15384 Freeland St, Detroit, MI 48227-2911 | 2016-08-15 |
| 1558815068 | Charlie Hudson | Residential Treatment Facility, Physical Disabilities | 15831 Woodworth, Redford, MI 48239-3970 | 2016-08-12 |
| 1801249222 | Cm Org | Residential Treatment Facility, Physical Disabilities | 7621 Parkland, Detroit, MI 48239-1031 | 2016-07-20 |
| 1548635618 | Milad Jabow | Residential Treatment Facility, Physical Disabilities | 5126 Allison Dr, Troy, MI 48085-3468 | 2015-12-01 |
| 1831568500 | Expert Enterprises | Residential Treatment Facility, Physical Disabilities | 18453 Woodingham Dr Uppr, Detroit, MI 48221-2155 | 2015-09-23 |
| 1396113767 | Ltss Inc | Residential Treatment Facility, Physical Disabilities | 3801 S 39 Rd, Cadillac, MI 49601-9126 | 2015-09-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.