MEDICARE: MR. LAMONT TERRANCE HICKS SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	5416303	MI

General Provider Information

NPI Number	:	1255116844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAMONT TERRANCE HICKS SR.

Provider Business Mailing Address
First Line	:	5362 MONROE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2527
Country	:	US
Telephone Number	:	734-882-0937
Fax Number	:

Provider Business Practice Location Address
First Line	:	5362 MONROE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2527
Country	:	US
Telephone Number	:	734-882-0937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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