Provider Demographics
NPI:1629611520
Name:THE LUMINOUS CARE LLC
Entity Type:Organization
Organization Name:THE LUMINOUS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-263-1514
Mailing Address - Street 1:2301 WEST SAMPLE ROAD
Mailing Address - Street 2:BLDG 4 STE 1B & 2B
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2102
Mailing Address - Country:US
Mailing Address - Phone:954-905-6225
Mailing Address - Fax:
Practice Address - Street 1:2301 W SAMPLE ROAD
Practice Address - Street 2:BLDG 4 SUITE 1B & 2B
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:954-263-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder