Healthcare Provider Details

I. General information

NPI: 1407567530
Provider Name (Legal Business Name): LUMINIS HEALTH DOCTORS COMMUNITY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK ROAD
LANHAM MD
20706
US

IV. Provider business mailing address

8118 GOOD LUCK ROAD
LANHAM MD
20706
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8118
  • Fax:
Mailing address:
  • Phone: 301-552-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY WARD
Title or Position: DIRECTOR REVENUE CYCLE OPTIMIZATION
Credential:
Phone: 667-204-7182