Healthcare Provider Details

I. General information

NPI: 1790620961
Provider Name (Legal Business Name): CHRISTOPHER G LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AMANDA M HARRIS

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SHORT PINK ST
WEST MONROE LA
71292-6317
US

IV. Provider business mailing address

100 SHORT PINK ST
WEST MONROE LA
71292-6317
US

V. Phone/Fax

Practice location:
  • Phone: 318-789-8729
  • Fax:
Mailing address:
  • Phone: 318-789-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2203786977
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: