Healthcare Provider Details

I. General information

NPI: 1679306567
Provider Name (Legal Business Name): BEACON OF LIGHT SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 S MAIN ST
SALISBURY NC
28144-6710
US

IV. Provider business mailing address

1708 S MAIN ST
SALISBURY NC
28144-6710
US

V. Phone/Fax

Practice location:
  • Phone: 980-248-7854
  • Fax:
Mailing address:
  • Phone: 980-248-7854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ANGELA KEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 980-248-7854