NPIMap

A Beam of Light LLC

Organization Active NPI Personal Care Attendant · Marrero, LA

NPI 1124200209 · NPPES record last updated Mar 27, 2015

Key facts

NPI
1124200209
Entity type
Organization (NPI type 2)
Primary specialty
Personal Care Attendant 3747P1801X
License
9793 (LA)
Legal business name
A BEAM OF LIGHT LLC
Practice address
5201 Westbank Expressway
Suite 315
Marrero, LA 70072
Phone
(504) 328-1627
Fax
(504) 328-1467
NPI assigned
Nov 30, 2007
Organization subpart
No

Authorized official

Name
Annette Revader
Title
Owner/Administrator
Phone
(504) 328-1627

Corporate family (same tax ID) 3

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
A Beam of Light LLC (4 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Care Attendant
Group: 193200000X MULTI-SPECIALTY GROUP		 3747P1801X 9793 LA Yes

Addresses

Primary practice location

5201 Westbank Expressway
Suite 315
Marrero, LA 70072

Mailing address

P O Box 925
Marrero, LA 70073
Phone (504) 328-1627

Other identifiers

IdentifierTypeStateIssuer
1105201MedicaidLA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 27, 2015.

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427414400000",
    "number": "1124200209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 925",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "70073",
            "telephone_number": "504-328-1627",
            "fax_number": "504-328-1467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 WESTBANK EXPRESSWAY",
            "address_2": "SUITE 315",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "70072",
            "telephone_number": "504-328-1627",
            "fax_number": "504-328-1467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BEAM OF LIGHT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2015-03-27",
        "status": "A",
        "authorized_official_last_name": "REVADER",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "504-328-1627"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": "LA",
            "license": "9793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1105201",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marrero, LA

All providers in Marrero, LA · Personal Care Attendant in Louisiana

Sources for this page

Verify at the official NPI Registry.