Provider Demographics
NPI:1720743594
Name:LUMINOUS HOMECARE LLC
Entity Type:Organization
Organization Name:LUMINOUS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:I
Authorized Official - Last Name:FAGBEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-806-2862
Mailing Address - Street 1:3312 NEW COACH LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1221
Mailing Address - Country:US
Mailing Address - Phone:301-806-2862
Mailing Address - Fax:
Practice Address - Street 1:3312 NEW COACH LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1221
Practice Address - Country:US
Practice Address - Phone:301-806-2862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health