Provider Demographics
NPI:1891688438
Name:BEACON OF HOPE LLC
Entity type:Organization
Organization Name:BEACON OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLABER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:513-516-9293
Mailing Address - Street 1:3481 S DIXIE HWY STE 267
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5717
Mailing Address - Country:US
Mailing Address - Phone:513-516-9293
Mailing Address - Fax:513-995-2281
Practice Address - Street 1:2555 S DIXIE DR STE 201
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1532
Practice Address - Country:US
Practice Address - Phone:513-516-9293
Practice Address - Fax:513-995-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-02
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty