Organization
LUMINARIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA LEA RIVERA (CHIEF EXECUTIVE OFFICER)
(520) 840-0431
Entity
Organization
Contact information
Practice address
17 DOUGLAS RD UNIT A, BISBEE, AZ 85603-1051
(520) 466-2233
Mailing address
17 A DOUGLAS HWY, BISBEE, AZ 85603
(520) 466-2233
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4451
AZ
Other
Enumeration date
04/07/2014
Last updated
04/07/2014
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