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General NPI Number Information
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NPI Number | 1205465507
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Entity Type | Organization
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Legal Business Name | LUCENT HEALTH, LLC
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 1110 PELICAN BAY DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-1381
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Country | US
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Telephone | 386-801-9940
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Fax |
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Provider Business Mailing Address
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Address Line | 157 ROSS LAKE LN
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City | SANFORD
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State | FL
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Zip | 32771-8109
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Country | US
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Telephone | 386-801-9940
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JERRY MICHAEL CUTRONA
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Credential |
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Telephone | 386-801-9940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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