MEDICARE: LUCAS HEALTH PARTNERS, 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1114086105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCAS HEALTH PARTNERS, LLC

Provider Business Mailing Address
First Line	:	3216 W. MANCHESTER BLVD.
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305
Country	:	US
Telephone Number	:	310-412-0200
Fax Number	:	310-412-0600

Provider Business Practice Location Address
First Line	:	3216 W. MANCHESTER BLVD.
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305
Country	:	US
Telephone Number	:	310-412-0200
Fax Number	:	310-412-0600

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ILYA VASKELL
Credential	:
Telephone Number	:	310-412-0200

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	06/25/2008

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