Provider Demographics
NPI:1851969778
Name:LUMIERE PURE BODY MED SPA LLC
Entity Type:Organization
Organization Name:LUMIERE PURE BODY MED SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-706-3315
Mailing Address - Street 1:711 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3095
Mailing Address - Country:US
Mailing Address - Phone:609-877-2800
Mailing Address - Fax:856-372-4660
Practice Address - Street 1:711 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3095
Practice Address - Country:US
Practice Address - Phone:609-877-2800
Practice Address - Fax:856-372-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty