Organization
A BEAM OF LIGHT LLC
Active
Organization
A BEAM OF LIGHT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE REVADER (OWNER/ADMINISTRATOR)
(504) 328-1627
Entity
Organization
Contact information
Practice address
5201 WEST BANK EXPRESSWAY, SUITE 315, MARRERO, LA 70072
(504) 328-1627
(504) 328-1467
Mailing address
PO BOX 925, MARRERO, LA 70073
(504) 328-1627
(504) 328-1467
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
9793
LA
Other
Enumeration date
11/30/2007
Last updated
04/03/2015
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