Healthcare Provider Details

I. General information

NPI: 1528995453
Provider Name (Legal Business Name): LANTERN OF HOPE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 NE LITTLE BEAVER DR
GRIMES IA
50111-4515
US

IV. Provider business mailing address

1855 NE LITTLE BEAVER DR
GRIMES IA
50111-4515
US

V. Phone/Fax

Practice location:
  • Phone: 512-750-0299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID SHYAKA
Title or Position: OWNER
Credential:
Phone: 512-750-0299