Healthcare Provider Details

I. General information

NPI: 1730781063
Provider Name (Legal Business Name): LUMICARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1810
US

IV. Provider business mailing address

620 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1810
US

V. Phone/Fax

Practice location:
  • Phone: 215-836-3131
  • Fax: 215-273-5975
Mailing address:
  • Phone: 215-836-3131
  • Fax: 215-273-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. NORMAN TILSON JR.
Title or Position: CORP SR. DIRECTOR OF BUSINESS OPS
Credential:
Phone: 215-836-3131