Provider Demographics
NPI:1558155291
Name:LUNA PEARL GROUP HOMES LLC
Entity type:Organization
Organization Name:LUNA PEARL GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANSEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:765-437-8573
Mailing Address - Street 1:14709 W PASADENA AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-2824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14709 W PASADENA AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-2824
Practice Address - Country:US
Practice Address - Phone:765-437-8573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home