Provider Demographics
NPI:1134515455
Name:LUMINANCE RECOVERY CENTER
Entity Type:Organization
Organization Name:LUMINANCE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-359-7326
Mailing Address - Street 1:27131 CALLE ARROYO STE 1703
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2700
Mailing Address - Country:US
Mailing Address - Phone:949-359-7300
Mailing Address - Fax:
Practice Address - Street 1:27126B PASEO ESPADA # B
Practice Address - Street 2:SUITE 721
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2721
Practice Address - Country:US
Practice Address - Phone:949-359-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder