MEDICARE: LUMINOUS PATHWAYS INC.

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

General Provider Information

NPI Number	:	1427736503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINOUS PATHWAYS INC.

Provider Business Mailing Address
First Line	:	1170 49TH AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1933
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 49TH AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1933
Country	:	US
Telephone Number	:	612-814-2053
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NAJMA JAMA
Credential	:
Telephone Number	:	612-814-2053

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/07/2023

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