Provider Demographics
NPI:1093211559
Name:LUX SENIOR CARE LLC
Entity Type:Organization
Organization Name:LUX SENIOR CARE LLC
Other - Org Name:LUX SENIOR CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRACDOR
Authorized Official - Prefix:
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:561-838-7165
Mailing Address - Street 1:6801 LAKE WORTH RD STE 322
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2966
Mailing Address - Country:US
Mailing Address - Phone:561-838-7165
Mailing Address - Fax:
Practice Address - Street 1:6801 LAKE WORTH RD STE 322
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2966
Practice Address - Country:US
Practice Address - Phone:561-838-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211951251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211951OtherSTATE LICENSE