Provider Demographics
NPI:1942219118
Name:LUMINOUS ENTERPRISES, L.L.C.
Entity Type:Organization
Organization Name:LUMINOUS ENTERPRISES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:D MIN
Authorized Official - Phone:828-859-2780
Mailing Address - Street 1:20 JERVEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-0017
Mailing Address - Country:US
Mailing Address - Phone:828-859-2780
Mailing Address - Fax:828-859-3057
Practice Address - Street 1:20 JERVEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-0017
Practice Address - Country:US
Practice Address - Phone:828-859-2780
Practice Address - Fax:828-859-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409386Medicaid