Healthcare Provider Details

I. General information

NPI: 1629611520
Provider Name (Legal Business Name): THE LUMINOUS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 COCONUT CREEK PKWY STE C
MARGATE FL
33063-3997
US

IV. Provider business mailing address

5080 COCONUT CREEK PKWY STE C
MARGATE FL
33063-3997
US

V. Phone/Fax

Practice location:
  • Phone: 954-263-1514
  • Fax:
Mailing address:
  • Phone: 954-905-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JAYESH DAVE
Title or Position: SOLE MBR
Credential:
Phone: 954-263-1514