Healthcare Provider Details

I. General information

NPI: 1790605020
Provider Name (Legal Business Name): LEWIS LEGACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14817 PECK DR
WARREN MI
48088-1579
US

IV. Provider business mailing address

16916 CARLISLE ST
DETROIT MI
48205-1545
US

V. Phone/Fax

Practice location:
  • Phone: 810-830-2828
  • Fax:
Mailing address:
  • Phone: 810-830-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SIOBHAN FABIANA BEASLEY
Title or Position: MANAGING MEMBER
Credential:
Phone: 810-830-2828