Healthcare Provider Details

I. General information

NPI: 1982024790
Provider Name (Legal Business Name): LUMINOUS CARES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EVERGREEN PL
EAST ORANGE NJ
07018-2011
US

IV. Provider business mailing address

134 EVERGREEN PL
EAST ORANGE NJ
07018-2011
US

V. Phone/Fax

Practice location:
  • Phone: 862-233-2133
  • Fax:
Mailing address:
  • Phone: 862-233-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number26NJ00374300
License Number StateNJ

VIII. Authorized Official

Name: DR. UDOKA JEREMIAH EJIOFOR
Title or Position: PRESIDENT AND PSYCH APN
Credential:
Phone: 862-233-2133