Provider Demographics
NPI:1548477227
Name:BENEFITS OF LIGHT LLC
Entity type:Organization
Organization Name:BENEFITS OF LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHULBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-844-6375
Mailing Address - Street 1:1144 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3314
Mailing Address - Country:US
Mailing Address - Phone:218-844-6375
Mailing Address - Fax:218-844-6376
Practice Address - Street 1:1144 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3314
Practice Address - Country:US
Practice Address - Phone:218-844-6375
Practice Address - Fax:218-844-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45F05BEMedicare UPIN