Provider Demographics
NPI:1518559848
Name:LIRA, LINDA EMMA (HOME CARE)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:EMMA
Last Name:LIRA
Suffix:
Gender:F
Credentials:HOME CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 W CLARK RD APT H103
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9426
Mailing Address - Country:US
Mailing Address - Phone:517-303-6446
Mailing Address - Fax:
Practice Address - Street 1:3505 W CLARK RD APT H103
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9426
Practice Address - Country:US
Practice Address - Phone:517-303-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8313407251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health