=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790027969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUMINA CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2013
-----------------------------------------------------
Last Update Date | 03/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2802 FLINTROCK TRCE SUITE 201
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78738-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-407-2606
-----------------------------------------------------
Fax | 512-407-2612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2802 FLINTROCK TRCE SUITE 201
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78738-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-407-2606
-----------------------------------------------------
Fax | 512-407-2612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GLENN P. SCOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-407-2606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------