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General NPI Number Information
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NPI Number | 1558070524
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Entity Type | Organization
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Legal Business Name | LEWIS SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 1015 SUNSET VIEW CT
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City | FOREST
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State | VA
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Zip | 24551-2127
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Country | US
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Telephone | 434-609-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 SUNSET VIEW CT
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City | FOREST
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State | VA
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Zip | 24551-2127
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Country | US
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Telephone | 434-609-5600
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | KETURAH MONIQUE LEWIS
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Credential | BS PSYCHOLOGY
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Telephone | 434-609-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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