Provider Demographics
NPI:1679379481
Name:ACTIVATING LIGHT STUDIO LLC
Entity type:Organization
Organization Name:ACTIVATING LIGHT STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:GARCIA-HALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:541-251-8677
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0003
Mailing Address - Country:US
Mailing Address - Phone:541-251-8677
Mailing Address - Fax:
Practice Address - Street 1:601 CHETCO AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-8010
Practice Address - Country:US
Practice Address - Phone:541-251-8677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty