| NPI | 1386219954 |
|---|---|
| Other Name | LIGHTHOUSE MENTORING CENTER 4 |
| Entity Type | Organization |
| Authorized Contact | PHYLLIS A RITTER Clinical Director 922-628-1641 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2022-06-03 |