Provider Demographics
NPI:1952140527
Name:HEALING LIGHT ADVOCACY, L.L.C.
Entity type:Organization
Organization Name:HEALING LIGHT ADVOCACY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:907-378-8700
Mailing Address - Street 1:1046 DOGWOOD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4324
Mailing Address - Country:US
Mailing Address - Phone:907-378-8700
Mailing Address - Fax:
Practice Address - Street 1:1046 DOGWOOD ST APT 10
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4324
Practice Address - Country:US
Practice Address - Phone:907-378-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1104879477Medicaid