Healthcare Provider Details

I. General information

NPI: 1487464970
Provider Name (Legal Business Name): LUMIWELL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 E CLINTON WAY STE 107
FRESNO CA
93727-2043
US

IV. Provider business mailing address

2705 N CARRIAGE AVE
FRESNO CA
93727-0957
US

V. Phone/Fax

Practice location:
  • Phone: 559-318-5004
  • Fax: 559-520-4819
Mailing address:
  • Phone: 559-478-3736
  • Fax: 559-520-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PA VUE
Title or Position: MANAGING PARTNER
Credential: RN
Phone: 559-478-3736