Provider Demographics
NPI:1922733765
Name:LEWIS, RIKKI MAYSON
Entity Type:Individual
Prefix:
First Name:RIKKI
Middle Name:MAYSON
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 HOMEWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4307
Mailing Address - Country:US
Mailing Address - Phone:216-242-8870
Mailing Address - Fax:
Practice Address - Street 1:513 HOMEWORTH AVE
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4307
Practice Address - Country:US
Practice Address - Phone:216-242-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator