Healthcare Provider Details

I. General information

NPI: 1063346849
Provider Name (Legal Business Name): MS. ELIZABETH LOUISE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20065 FENTON ST
DETROIT MI
48219-1065
US

IV. Provider business mailing address

20065 FENTON ST
DETROIT MI
48219-1065
US

V. Phone/Fax

Practice location:
  • Phone: 678-683-0174
  • Fax:
Mailing address:
  • Phone: 678-683-0174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7806952
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: