LIGHT HOUSE GROUP HOME LLC (NPI# 1316505753) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316505753 |
| Entity Type | Organization |
| Organization Name | LIGHT HOUSE GROUP HOME LLC |
| Practice Address |
108 E 2nd Ave Mesa AZ 85210-1410 |
| Mailing Address |
9713 E El Paso St Mesa AZ 85207-5351 |
| Practice Telephone | 4803320385 |
| Mailing Telephone | 4803320385 |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2019-05-31 |
| Authorized Official Name | JEFF PRESUTTI (CEO) |
| Authorized Official Telephone | 4803320385 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154940864 | Light House Group Home LLC | Clinic/Center | 108 E 2nd Ave Ste 101, Mesa, AZ 85210-1410 | 2020-04-13 |
| Street Address |
108 E 2ND AVE |
| City | MESA |
| State | AZ |
| Zip Code | 85210-1410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376729509 | Sara Care Inc | Assisted Living Facility | 108 E 2nd Ave, Mesa, AZ 85210-1410 | 2008-01-17 |
| 1255940649 | Empact - Suicide Prevention Center | Community Based Residential Treatment Facility, Mental Illness | 108 E 2nd Ave, Mesa, AZ 85210-1410 | 2020-07-30 |
| 1336454867 | The River Source | Substance Abuse Rehabilitation Facility | 108 E 2nd Ave, Mesa, AZ 85210-1410 | 2010-08-09 |
| 1467680165 | Cho Long Elizabeth Kim | Internal Medicine | 108 E 2nd Ave, Mesa, AZ 85210-1410 | 2009-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497382501 | Mesa Center for Family Medicine | Internal Medicine | 2034 S Alma School Road, Suite #101, Mesa, AZ 85210 | 2020-03-26 |
| 1780177121 | Jessica Cannata | Speech-Language Pathologist | 2150 S Country Club Rd, Suite 20, Mesa, AZ 85210 | 2018-06-11 |
| 1831680305 | Alexandra Katherine Ebong | Nurse Practitioner | 1950 S. Country Club Drive, Ste 102, Mesa, AZ 85210 | 2018-05-21 |
| 1548762719 | Russell D. Meldrum, M.d. Pllc | Orthopaedic Surgery | 855 W. Southern Ave., #1114, Mesa, AZ 85210 | 2018-03-05 |
| 1023510435 | Denise M Bruno-krupp | Counselor | 1830 S. Alma School Rd. Suite 101, Mesa, AZ 85210 | 2018-03-01 |
| 1609374529 | Gene R Lullo | Social Worker | 1830 S Alma School Rd Suite 101, Mesa, AZ 85210 | 2018-01-25 |
| 1295264000 | Ashley P Smith | Naturopath | 601 S Alma School Rd, Apt 101, Mesa, AZ 85210 | 2017-06-06 |
| 1386184059 | Brittany Johnson | Counselor | 1745 S Alma School Rd Ste 230, Mesa, AZ 85210 | 2017-03-01 |
| 1487190880 | Mesa Valley Modern Dentistry, LLP | Dentist | 1712 S, Country Club Drive, Ste 104, Mesa, AZ 85210 | 2017-01-10 |
| 1821544529 | Sandra Coren | Licensed Practical Nurse | 32 S Mcdonald, Tlc, Mesa, AZ 85210 | 2016-09-01 |
| Find all providers in zip 85210 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073179883 | Dara II Inc | Substance Abuse Rehabilitation Facility | 4645 E Ellis Cir, Mesa, AZ 85205-5238 | 2019-05-16 |
| 1417458753 | Reboot Detox Az LLC | Substance Abuse Rehabilitation Facility | 1132 S Oakland, Mesa, AZ 85206-2682 | 2018-02-22 |
| 1326491283 | Soba Mesa LLC | Substance Abuse Rehabilitation Facility | 6215 E Arbor Ave, Mesa, AZ 85206-6064 | 2016-07-15 |
| 1841649258 | Big Sky Recovery LLC | Substance Abuse Rehabilitation Facility | 2360 N Robin Ln, Mesa, AZ 85213-2474 | 2016-06-07 |
| 1104209352 | Recovery Homes, Inc | Substance Abuse Rehabilitation Facility | 141 South Center Street, Suite B, Mesa, AZ 85210 | 2015-07-07 |
| 1710369483 | Recovery Homes, Inc | Substance Abuse Rehabilitation Facility | 143 S Center St, Suite A, Mesa, AZ 85210-1307 | 2015-06-18 |
| 1306243084 | Residents At The Heights LLC | Substance Abuse Rehabilitation Facility | 215 S Power Rd Ste 1251, Mesa, AZ 85206-5238 | 2014-11-25 |
| 1538599469 | The River Source Iop LLC | Substance Abuse Rehabilitation Facility | 128 W Pepper Pl, Mesa, AZ 85201-7317 | 2013-11-13 |
| 1578807145 | Recovery Help, LLC. | Substance Abuse Rehabilitation Facility | 3945 E Broadway Rd, Mesa, AZ 85206-1030 | 2012-11-20 |
| 1497833644 | Anasazi Foundation | Substance Abuse Rehabilitation Facility | 1424 S Stapley Dr, Mesa, AZ 85204-5877 | 2006-11-02 |
| Find all providers in MESA | ||||
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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.