MEDICARE: LUMINA HOSPICE AND PALLIATIVE CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1164429817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINA HOSPICE AND PALLIATIVE CARE

Provider Business Mailing Address
First Line	:	720 SW 4TH ST
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97333-4426
Country	:	US
Telephone Number	:	541-757-9616
Fax Number	:	541-757-1760

Provider Business Practice Location Address
First Line	:	720 SW 4TH ST
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97333-4426
Country	:	US
Telephone Number	:	541-757-9616
Fax Number	:	541-757-1760

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	AMY BAIRD
Credential	:
Telephone Number	:	541-757-9616

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/28/2022

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Directions to “LUMINA HOSPICE AND PALLIATIVE CARE ” Practice Location

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