Provider Demographics
NPI:1285253286
Name:ILLUMINATION FOUNDATION
Entity type:Organization
Organization Name:ILLUMINATION FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RECUPERATIVE CARE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:714-261-5392
Mailing Address - Street 1:1091 N BATAVIA ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5548
Mailing Address - Country:US
Mailing Address - Phone:949-273-0555
Mailing Address - Fax:
Practice Address - Street 1:1091 N BATAVIA ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5548
Practice Address - Country:US
Practice Address - Phone:949-273-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No251X00000XAgenciesSupports Brokerage
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty