Provider Demographics
NPI:1679282586
Name:BEAM OF LIGHT HEALTH SERVICES INC
Entity type:Organization
Organization Name:BEAM OF LIGHT HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JOWHARAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHRM
Authorized Official - Phone:480-749-8865
Mailing Address - Street 1:3201 W PEORIA AVE STE C603
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4611
Mailing Address - Country:US
Mailing Address - Phone:480-749-8865
Mailing Address - Fax:602-926-2414
Practice Address - Street 1:3201 W PEORIA AVE STE C603
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4611
Practice Address - Country:US
Practice Address - Phone:480-749-8865
Practice Address - Fax:602-926-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health