Provider Demographics
NPI:1164180071
Name:ILLUMINOUS HEALTH, LLC
Entity Type:Organization
Organization Name:ILLUMINOUS HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-841-1229
Mailing Address - Street 1:4581 ASHTON RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3405
Mailing Address - Country:US
Mailing Address - Phone:941-841-1229
Mailing Address - Fax:
Practice Address - Street 1:3900 CLARK RD STE 2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2301
Practice Address - Country:US
Practice Address - Phone:941-841-1229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service