Provider Demographics
NPI:1588812887
Name:A SHINING LIGHT, INC.
Entity Type:Organization
Organization Name:A SHINING LIGHT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAPRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-797-2925
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-0045
Mailing Address - Country:US
Mailing Address - Phone:540-797-2928
Mailing Address - Fax:540-966-2744
Practice Address - Street 1:107 AZALEA RD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3522
Practice Address - Country:US
Practice Address - Phone:540-797-2925
Practice Address - Fax:540-966-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1197-01-001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities