1588812887 NPI number — A SHINING LIGHT, INC.

Table of content: (NPI 1588812887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588812887 NPI number — A SHINING LIGHT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A SHINING LIGHT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588812887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARDY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24101-0045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-797-2928
Provider Business Mailing Address Fax Number:
540-966-2744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 AZALEA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALEVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24083-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-797-2925
Provider Business Practice Location Address Fax Number:
540-966-2744
Provider Enumeration Date:
08/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAPRAD
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
540-797-2925

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  1197-01-001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)