Provider Demographics
NPI:1740086735
Name:LUCID HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:LUCID HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERMAIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KUMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-887-0930
Mailing Address - Street 1:3192 TULIP TREE PL
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-4554
Mailing Address - Country:US
Mailing Address - Phone:703-887-0930
Mailing Address - Fax:
Practice Address - Street 1:3192 TULIP TREE PL
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-4554
Practice Address - Country:US
Practice Address - Phone:703-887-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-0005598OtherHOME CARE ORGANIZATION