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General NPI Number Information
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NPI Number | 1306370192
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Entity Type | Organization
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Legal Business Name | LUMINANCE HEALTH GROUP, INC.
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 24662 EL CAMINO CAPISTRANO
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City | DANA POINT
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State | CA
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Zip | 92629-3012
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Country | US
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Telephone | 949-482-8315
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 268866
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-8866
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL CASTANON
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Credential |
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Telephone | 310-303-8325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | CA
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