| NPI | 1154303162 |
|---|---|
| Doing Business As | PENINSULA LIGHTHOUSE PENINSULA OUTPATIENT CENTER |
| Entity Type | Organization |
| Authorized Contact | JOHN T GEPPI Executive Vice President CFO 865-374-6872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: TN L 2(14)M5-076-1466) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: TN L 2(14)M5-076-1466) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2020-08-22 |