MEDICARE: LUMICARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	2251P0200X	Pediatric Physical Therapist
3	225XP0200X	Pediatric Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	2355S0801X	Speech-Language Assistant
6	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1992591929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMICARE, LLC

Provider Business Mailing Address
First Line	:	4150 W PEORIA AVE STE 117
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 W PEORIA AVE STE 117
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3950
Country	:	US
Telephone Number	:	626-345-4626
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NICHELLE DEAN
Credential	:
Telephone Number	:	626-345-4626

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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Directions to “LUMICARE, LLC ” Practice Location

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