Healthcare Provider Details

I. General information

NPI: 1720906548
Provider Name (Legal Business Name): LUMINATE WELLNESS AND RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17901 MEDLEY DR
ENCINO CA
91316-4342
US

IV. Provider business mailing address

17901 MEDLEY DR
ENCINO CA
91316-4342
US

V. Phone/Fax

Practice location:
  • Phone: 310-740-6162
  • Fax:
Mailing address:
  • Phone: 310-740-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: YVETTE NOWRY
Title or Position: CEO
Credential: RN, BSN
Phone: 818-437-4168