MEDICARE: LUCINMA HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1083376222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCINMA HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	8302 FAWN TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-3654
Country	:	US
Telephone Number	:	713-541-3420
Fax Number	:

Provider Business Practice Location Address
First Line	:	8302 FAWN TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-3654
Country	:	US
Telephone Number	:	713-541-3420
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. OBIAUKOR MOKOLO
Credential	:
Telephone Number	:	713-541-3420

Provider Enumeration Date	:	10/05/2021
Last Update Date	:	10/05/2021

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