Healthcare Provider Details

I. General information

NPI: 1508693185
Provider Name (Legal Business Name): LILLYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 01/24/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 E HOWE RD
DEWITT MI
48820-9408
US

IV. Provider business mailing address

3003 E MICHIGAN AVE # 1235
LANSING MI
48912-4616
US

V. Phone/Fax

Practice location:
  • Phone: 517-402-8905
  • Fax:
Mailing address:
  • Phone: 517-402-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GERDING
Title or Position: OWNER
Credential:
Phone: 517-402-8905