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General NPI Number Information
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NPI Number | 1588812887
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Entity Type | Organization
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Legal Business Name | A SHINING LIGHT, INC.
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 107 AZALEA RD
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City | DALEVILLE
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State | VA
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Zip | 24083-3522
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Country | US
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Telephone | 540-797-2925
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Fax | 540-966-2744
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Provider Business Mailing Address
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Address Line | PO BOX 45
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City | HARDY
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State | VA
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Zip | 24101-0045
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Country | US
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Telephone | 540-797-2928
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Fax | 540-966-2744
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DAWN A LAPRAD
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Credential |
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Telephone | 540-797-2925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 1197-01-001
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License Number State | VA
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