Provider Demographics
NPI:1750510541
Name:RAY OF LIGHT HOLISTIC HEALTH, INC.
Entity Type:Organization
Organization Name:RAY OF LIGHT HOLISTIC HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIDLAW
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CMT
Authorized Official - Phone:574-264-2600
Mailing Address - Street 1:1709 E BRISTOL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-6606
Mailing Address - Country:US
Mailing Address - Phone:574-264-2600
Mailing Address - Fax:
Practice Address - Street 1:1709 E BRISTOL ST
Practice Address - Street 2:SUITE B
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-6606
Practice Address - Country:US
Practice Address - Phone:574-264-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000025A171100000X
173C00000X, 225700000X
INMT20900230225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty