Organization
BEACON OF LIFE WELLNESS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNA BARNES (MANAGING MEMBER / ADMINISTRATOR)
(702) 845-2862
Entity
Organization
Contact information
Practice address
2300 N RAINBOW BLVD UNIT 113, LAS VEGAS, NV 89108-7350
(702) 845-2862
Mailing address
5840 W CRAIG RD # 120-260, LAS VEGAS, NV 89130-2561
(702) 845-2862
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
01/13/2022
Last updated
01/24/2022
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