Provider Demographics
NPI:1164429817
Name:LUMINA HOSPICE AND PALLIATIVE CARE
Entity Type:Organization
Organization Name:LUMINA HOSPICE AND PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-757-9616
Mailing Address - Street 1:720 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4426
Mailing Address - Country:US
Mailing Address - Phone:541-757-9616
Mailing Address - Fax:541-757-1760
Practice Address - Street 1:720 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4426
Practice Address - Country:US
Practice Address - Phone:541-757-9616
Practice Address - Fax:541-757-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38-1519Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER