Healthcare Provider Details

I. General information

NPI: 1285939611
Provider Name (Legal Business Name): LEWIS INSURANCE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2011
Last Update Date: 01/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8304 GRANDMONT RD
DETROIT MI
48228-2288
US

IV. Provider business mailing address

PO BOX 44234
DETROIT MI
48244-0234
US

V. Phone/Fax

Practice location:
  • Phone: 313-977-0051
  • Fax:
Mailing address:
  • Phone: 313-977-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0325305
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number0325305
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0325305
License Number StateMI

VIII. Authorized Official

Name: VALLORIE B LEWIS
Title or Position: PRESIDENT
Credential: NONE
Phone: 313-977-0051