Provider Demographics
NPI:1669184339
Name:LUMINOUS MIND CARE LLC
Entity type:Organization
Organization Name:LUMINOUS MIND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELFORT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:954-478-0553
Mailing Address - Street 1:17145 HAMLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-1759
Mailing Address - Country:US
Mailing Address - Phone:954-478-0553
Mailing Address - Fax:
Practice Address - Street 1:17145 HAMLIN BLVD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-1759
Practice Address - Country:US
Practice Address - Phone:954-478-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health