Healthcare Provider Details

I. General information

NPI: 1235135005
Provider Name (Legal Business Name): LEWIS WHEELCHAIR REPAIR & SALES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 INDUSTRY DR
SIGNAL HILL CA
90755-4013
US

IV. Provider business mailing address

3289 INDUSTRY DR
SIGNAL HILL CA
90755-4013
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-1026
  • Fax: 562-494-6895
Mailing address:
  • Phone: 562-597-1026
  • Fax: 562-494-6895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number101205
License Number StateCA

VIII. Authorized Official

Name: MR. LARRY E. LEVASSEUR
Title or Position: CONTROLLER
Credential:
Phone: 562-597-1026