Provider Demographics
NPI:1386375269
Name:BEACON OF STRENGTH SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:BEACON OF STRENGTH SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LACLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:701-946-0988
Mailing Address - Street 1:1119 UNIVERSITY DR LOT 1609
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6614
Mailing Address - Country:US
Mailing Address - Phone:701-946-0988
Mailing Address - Fax:
Practice Address - Street 1:205 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1928
Practice Address - Country:US
Practice Address - Phone:218-461-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care