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General NPI Number Information
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NPI Number | 1891688438
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Entity Type | Organization
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Legal Business Name | BEACON OF HOPE LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2555 S DIXIE DR STE 201
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City | DAYTON
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State | OH
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Zip | 45409-1532
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Country | US
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Telephone | 513-516-9293
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Fax | 513-995-2281
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Provider Business Mailing Address
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Address Line | 3481 S DIXIE HWY STE 267
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City | MIDDLETOWN
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State | OH
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Zip | 45005-5717
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Country | US
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Telephone | 513-516-9293
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Fax | 513-995-2281
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Authorized Official
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Title or Position | OWNER
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Name | SHANE KLABER
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Credential | PMHNP-BC
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Telephone | 513-516-9293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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