MEDICARE: ILLUMINATED DIRECTION

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1609286145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLUMINATED DIRECTION

Provider Business Mailing Address
First Line	:	2628 CAMELLIA DR
Second Line	:	APT C
City	:	DURHAM
State	:	NC
Zip	:	27705-2054
Country	:	US
Telephone Number	:	919-452-7931
Fax Number	:	888-227-5443

Provider Business Practice Location Address
First Line	:	800 N MANGUM ST STE 104
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27701-2260
Country	:	US
Telephone Number	:	919-450-6446
Fax Number	:	888-227-5443

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JONATHAN DALANDISH LACEWELL
Credential	:
Telephone Number	:	919-452-7931

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/06/2014

Similar Medicare Providers

1558122408 — STEPHANIE CHANEE MARSHALL
Practice Location Address:

800 N MANGUM ST
DURHAM, NC
27701-2260

Practice Phone: 919-683-1607
Practice Fax:

1437305331 — PROGRESSIVE INTERVENTIONS, INC.
Practice Location Address:

800 N MANGUM ST , SUITE 111B
DURHAM, NC
27701-2260

Practice Phone: 919-519-7757
Practice Fax:

1083845648 — INTEGRITY INTERVENTION SERVICES, LLC
Practice Location Address:

800 N MANGUM ST
DURHAM, NC
27701-2260

Practice Phone: 919-641-8378
Practice Fax: 919-379-3259

1467752410 — TIONA LATOYA GIBBS LCMHC
Practice Location Address:

800 N MANGUM ST STE 103
DURHAM, NC
27701-2260

Practice Phone: 919-824-2321
Practice Fax: 877-664-2842

1851712137 — MR. JONATHAN LACEWELL
Practice Location Address:

800 N MANGUM ST STE 104
DURHAM, NC
27701-2260

Practice Phone: 919-450-6446
Practice Fax: 888-227-5443

1104281773 — HILDA MARIE SMITH LCAS
Practice Location Address:

800 N MANGUM ST STE 400
DURHAM, NC
27701-2260

Practice Phone: 919-683-1607
Practice Fax: 919-683-1790

Directions to “ILLUMINATED DIRECTION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.