Provider Demographics
NPI:1114662764
Name:LUKE LLC
Entity Type:Organization
Organization Name:LUKE LLC
Other - Org Name:FAITH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:DIRAR
Authorized Official - Middle Name:BERHE
Authorized Official - Last Name:NEGASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-503-7506
Mailing Address - Street 1:19 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1534
Mailing Address - Country:US
Mailing Address - Phone:720-503-7506
Mailing Address - Fax:
Practice Address - Street 1:19 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1534
Practice Address - Country:US
Practice Address - Phone:720-503-7506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)