Provider Demographics
NPI:1770034043
Name:LUCRUMARE INC
Entity Type:Organization
Organization Name:LUCRUMARE INC
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:PODEMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-275-4550
Mailing Address - Street 1:2037 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-4809
Mailing Address - Country:US
Mailing Address - Phone:815-275-4550
Mailing Address - Fax:
Practice Address - Street 1:4835 MANHATTAN DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2265
Practice Address - Country:US
Practice Address - Phone:815-229-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care