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General NPI Number Information
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NPI Number | 1922834100
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE BEACON OF HOPE
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 3925 SHERBROOK RD
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City | RICHMOND
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State | VA
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Zip | 23235-2023
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Country | US
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Telephone | 888-340-5305
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Fax |
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Provider Business Mailing Address
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Address Line | 514 DANIELS ST STE 157
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City | RALEIGH
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State | NC
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Zip | 27605-1317
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Country | US
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Telephone | 888-340-5305
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Fax |
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Authorized Official
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Title or Position | QP AND INSTUCTOR
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Name | MRS. CHARMAINE FAYE DRAUGHN-LIGHTNER
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Credential | BA BS
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Telephone | 888-340-5305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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