Provider Demographics
NPI:1366216624
Name:LUMINIS HEALTH GILCHRIST LIFECARE INSTITUTE, LLC
Entity type:Organization
Organization Name:LUMINIS HEALTH GILCHRIST LIFECARE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MODDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-849-8302
Mailing Address - Street 1:11311 MCCORMICK RD STE 350
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-8618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL PKWY STE 607
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3748
Practice Address - Country:US
Practice Address - Phone:443-322-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD317230901Medicaid