Healthcare Provider Details

I. General information

NPI: 1801696943
Provider Name (Legal Business Name): MS. BIANCA B LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 W 87TH ST
LOS ANGELES CA
90044-2112
US

IV. Provider business mailing address

1262 W 87TH ST
LOS ANGELES CA
90044-2112
US

V. Phone/Fax

Practice location:
  • Phone: 818-300-5167
  • Fax:
Mailing address:
  • Phone: 818-300-5167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: