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General NPI Number Information
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NPI Number | 1285939611
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Entity Type | Organization
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Legal Business Name | LEWIS INSURANCE AGENCY LLC
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Dates
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Enumeration Date | 01/15/2011
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Last Update Date | 01/15/2011
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Provider Practice Location Address
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Address Line | 8304 GRANDMONT RD
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City | DETROIT
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State | MI
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Zip | 48228-2288
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Country | US
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Telephone | 313-977-0051
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44234
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City | DETROIT
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State | MI
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Zip | 48244-0234
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Country | US
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Telephone | 313-977-0051
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VALLORIE B LEWIS
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Credential | NONE
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Telephone | 313-977-0051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number | 0325305
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 0325305
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0325305
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License Number State | MI
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