Provider Demographics
NPI:1972536084
Name:LUMINA OF CAMPBELLSVILLE
Entity type:Organization
Organization Name:LUMINA OF CAMPBELLSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEYOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-245-0767
Mailing Address - Street 1:2020 HODGENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8466
Mailing Address - Country:US
Mailing Address - Phone:270-849-2312
Mailing Address - Fax:270-849-2406
Practice Address - Street 1:2020 HODGENVILLE RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8466
Practice Address - Country:US
Practice Address - Phone:270-849-2312
Practice Address - Fax:270-849-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002216225100000X
KYR1581225X00000X
KYR2779225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9407Medicare ID - Type UnspecifiedMEDICARE NUMBER