Provider Demographics
NPI:1326764861
Name:LUMINARY HOSPICE OF INDIANA, LLC.
Entity Type:Organization
Organization Name:LUMINARY HOSPICE OF INDIANA, LLC.
Other - Org Name:LUMINARY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-767-3220
Mailing Address - Street 1:11708 N. COLLEGE AVE. STE. 175
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-814-6190
Mailing Address - Fax:866-607-1841
Practice Address - Street 1:11708 N. COLLEGE AVE. STE. 175
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-814-6190
Practice Address - Fax:317-814-6191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUMINARY HOSPICE OF INDIANA AND OHIO, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based