Healthcare Provider Details

I. General information

NPI: 1285253286
Provider Name (Legal Business Name): ILLUMINATION HEALTH AND HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 S ANAHEIM BLVD
ANAHEIM CA
92805-5204
US

IV. Provider business mailing address

2871 PULLMAN ST
SANTA ANA CA
92705-5713
US

V. Phone/Fax

Practice location:
  • Phone: 949-273-0555
  • Fax:
Mailing address:
  • Phone: 949-273-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. POOJA BHALLA
Title or Position: CEO
Credential: DNP,RN
Phone: 949-502-0339