MEDICARE: BEACON OF LIGHT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821742438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON OF LIGHT CARE LLC

Provider Business Mailing Address
First Line	:	2424 FRANKLIN ST # 203
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4562
Country	:	US
Telephone Number	:	219-292-7555
Fax Number	:	219-814-4941

Provider Business Practice Location Address
First Line	:	2424 FRANKLIN ST # 203
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4562
Country	:	US
Telephone Number	:	219-292-7555
Fax Number	:	219-814-4941

Authorized Official
Title or Position	:	MANAGER
Name	:	LATISHA KENDLE
Credential	:
Telephone Number	:	219-292-7555

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	12/30/2025

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Directions to “BEACON OF LIGHT CARE LLC ” Practice Location

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