Provider Demographics
NPI:1013256213
Name:ILLUMINATION FOUNDATION
Entity type:Organization
Organization Name:ILLUMINATION FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:POOJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN
Authorized Official - Phone:949-273-0555
Mailing Address - Street 1:2871 PULLMAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5713
Mailing Address - Country:US
Mailing Address - Phone:949-273-0555
Mailing Address - Fax:888-517-7123
Practice Address - Street 1:2030 IOWA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7416
Practice Address - Country:US
Practice Address - Phone:949-273-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage