MEDICARE: LUMINOUS LIFE CARE SERVICES INC

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1841057171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINOUS LIFE CARE SERVICES INC

Provider Business Mailing Address
First Line	:	13607 WOOD EMBER DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-4201
Country	:	US
Telephone Number	:	240-491-7953
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 OGLETHORPE ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2735
Country	:	US
Telephone Number	:	202-713-7890
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHIMEZIE F ONYIMA
Credential	:	CEO
Telephone Number	:	240-491-7953

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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