Provider Demographics
NPI:1821603010
Name:ILLUMINATED DIRECTION LLC
Entity Type:Organization
Organization Name:ILLUMINATED DIRECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL PROJECTS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:NOYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-223-4571
Mailing Address - Street 1:2628 CAMELLIA DR APT C
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:312 N CHARLES ST STE 300&400
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4360
Practice Address - Country:US
Practice Address - Phone:443-955-0048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder