Healthcare Provider Details

I. General information

NPI: 1720600042
Provider Name (Legal Business Name): LUMANA LTD. CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E INDIANOLA AVE
PHOENIX AZ
85012-2002
US

IV. Provider business mailing address

1001 S MAIN ST STE 5125
KALISPELL MT
59901-5635
US

V. Phone/Fax

Practice location:
  • Phone: 702-329-0700
  • Fax:
Mailing address:
  • Phone: 702-329-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FIONDA WILLIAMS BROCK
Title or Position: CEO
Credential: RN
Phone: 702-329-0799