LUMISCOPE HEALTH SERVICES

Provider Demographics

• NPI: 1598376659
• Name: LUMISCOPE HEALTH SERVICES
• Entity Type: Organization
• Organization Name: LUMISCOPE HEALTH SERVICES
• Authorized Official - Title/Position: EXECUTIVE PROGRAM DIRECTOR
• Authorized Official - Prefix: MS
• Authorized Official - First Name: OLUWAPELUMI
• Authorized Official - Last Name: OLUKOTUN
• Authorized Official - Credentials: BSN, MSHA, APRN, CCM
• Authorized Official - Phone: 571-400-8461
• Mailing Address - Street 1: 155 L ST NW
• Mailing Address - City: WASHINGTON
• Mailing Address - State: DC
• Mailing Address - Zip Code: 20001-2521
• Mailing Address - Country: US
• Mailing Address - Phone: 571-400-8461
• Practice Address - Street 1: 155 L ST NW
• Practice Address - City: WASHINGTON
• Practice Address - State: DC
• Practice Address - Zip Code: 20001-2521
• Practice Address - Country: US
• Practice Address - Phone: 571-400-8461
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: HERO'S SHELTER INC.
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2020-08-12
• Last Update Date: 2020-08-13

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	261QH0100X	Ambulatory Health Care Facilities	Clinic/Center	Health Service
No	251300000X	Agencies	Local Education Agency (LEA)
No	251B00000X	Agencies	Case Management
No	251E00000X	Agencies	Home Health
No	251G00000X	Agencies	Hospice Care, Community Based
No	251J00000X	Agencies	Nursing Care
No	251K00000X	Agencies	Public Health or Welfare
No	251S00000X	Agencies	Community/Behavioral Health
No	251T00000X	Agencies	Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
No	261QC1500X	Ambulatory Health Care Facilities	Clinic/Center	Community Health
No	261QC1800X	Ambulatory Health Care Facilities	Clinic/Center	Corporate Health
No	261QP2300X	Ambulatory Health Care Facilities	Clinic/Center	Primary Care

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WI	999999999999	Medicaid
GA	999999999999	Medicaid
LA	999999999999	Medicaid
DC	999999999999	Medicaid
MA	999999999999	Medicaid
IL	999999999999	Medicaid
VA	999999999999	Medicaid
AK	999999999999	Medicaid
CT	999999999999	Medicaid
DE	999999999999	Medicaid
NJ	999999999999	Medicaid
FL	999999999999	Medicaid
NY	999999999999	Medicaid
MD	999999999999	Medicaid
CA	999999999999	Medicaid
IN	999999999999	Medicaid
AL	999999999999	Medicaid
KY	999999999999	Medicaid
HI	999999999999	Medicaid
TX	999999999999	Medicaid
OH	999999999999	Medicaid
MS	999999999999	Medicaid
CO	999999999999	Medicaid
NE	999999999999	Medicaid
VT	999999999999	Medicaid
IA	999999999999	Medicaid
UT	999999999999	Medicaid
MO	999999999999	Medicaid
NC	999999999999	Medicaid