Provider Demographics
NPI:1669047122
Name:BEACON OF LIGHT TRANSPORTATION, LLC
Entity type:Organization
Organization Name:BEACON OF LIGHT TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-493-1516
Mailing Address - Street 1:11534 ASHTON FIELD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2374
Mailing Address - Country:US
Mailing Address - Phone:813-493-0051
Mailing Address - Fax:
Practice Address - Street 1:11534 ASHTON FIELD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2374
Practice Address - Country:US
Practice Address - Phone:813-493-0051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)