Provider Demographics
NPI:1306461363
Name:LIGHT BEAM HOSPICE, INC.
Entity type:Organization
Organization Name:LIGHT BEAM HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:O
Authorized Official - Last Name:CANETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-290-3860
Mailing Address - Street 1:120 N. VICTORY BOULEVARD SUITE 106
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-0001
Mailing Address - Country:US
Mailing Address - Phone:818-290-3860
Mailing Address - Fax:818-290-3885
Practice Address - Street 1:120 N. VICTORY BOULEVARD, SUITE 106
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-0001
Practice Address - Country:US
Practice Address - Phone:818-290-3860
Practice Address - Fax:818-290-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based