Provider Demographics
NPI:1598485732
Name:BEACON OF STRENGTH SUPPORTIVE SERVICES, LLC
Entity Type:Organization
Organization Name:BEACON OF STRENGTH SUPPORTIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:218-461-2118
Mailing Address - Street 1:205 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1928
Mailing Address - Country:US
Mailing Address - Phone:218-461-2118
Mailing Address - Fax:
Practice Address - Street 1:205 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1928
Practice Address - Country:US
Practice Address - Phone:218-461-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty