Healthcare Provider Details

I. General information

NPI: 1033508114
Provider Name (Legal Business Name): LUMINIS HEALTH PATHWAYS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 RIVA RD
ANNAPOLIS MD
21401-7305
US

IV. Provider business mailing address

PO BOX 64725
BALTIMORE MD
21264-4725
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-5454
  • Fax:
Mailing address:
  • Phone: 410-573-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number903106
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number903106
License Number StateMD

VIII. Authorized Official

Name: MS. HELEN REINES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-573-5454