Provider Demographics
NPI:1326732892
Name:YOUR LIGHT SO SHINES LLC
Entity Type:Organization
Organization Name:YOUR LIGHT SO SHINES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMBERLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:303-895-1692
Mailing Address - Street 1:7440 KINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9013
Mailing Address - Country:US
Mailing Address - Phone:303-895-1692
Mailing Address - Fax:
Practice Address - Street 1:2335 W MAIN ST STE 330
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2435
Practice Address - Country:US
Practice Address - Phone:303-895-1692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service