Provider Demographics
NPI:1366678336
Name:LUMEA STAFF OF IL INC
Entity Type:Organization
Organization Name:LUMEA STAFF OF IL INC
Other - Org Name:MERCY NURSING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-488-3882
Mailing Address - Street 1:3917 E LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-9740
Mailing Address - Country:US
Mailing Address - Phone:815-625-7764
Mailing Address - Fax:815-625-9807
Practice Address - Street 1:3917 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-9740
Practice Address - Country:US
Practice Address - Phone:815-625-7764
Practice Address - Fax:815-625-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011135251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
50147OtherBLUE CROSS BLUE SHIELD
IL=========0001Medicaid
IL561000Medicare PIN