Provider Demographics
NPI:1568653053
Name:LUCAS HEALTH PARTNERS LLC
Entity Type:Organization
Organization Name:LUCAS HEALTH PARTNERS LLC
Other - Org Name:MORNINGSIDE ADHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGRAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-412-0200
Mailing Address - Street 1:11225 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2835
Mailing Address - Country:US
Mailing Address - Phone:310-412-0200
Mailing Address - Fax:424-800-2082
Practice Address - Street 1:11225 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2835
Practice Address - Country:US
Practice Address - Phone:310-412-0200
Practice Address - Fax:424-800-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06000074261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70262FMedicaid