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General NPI Number Information
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NPI Number | 1487193918
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Entity Type | Organization
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Legal Business Name | LUMINARIA, LLC
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 28658 ARIZONA AVENUE
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City | WELLTON
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State | AZ
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Zip | 85356
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Country | US
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Telephone | 520-466-2233
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Fax | 520-466-2242
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Provider Business Mailing Address
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Address Line | 4040 N DEL MONTE DR
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City | ELOY
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State | AZ
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Zip | 85131-1506
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Country | US
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Telephone | 520-466-2233
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Fax | 520-466-2242
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. LAURA LEA RIVERA
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Credential |
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Telephone | 520-840-0431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | BH5056
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License Number State | AZ
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