Provider Demographics
NPI:1942567193
Name:LEWIS HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:LEWIS HEALTH SERVICES, INC
Other - Org Name:NICOLE LEWIS MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASSAGE THERARPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP, LMT, MMP
Authorized Official - Phone:360-989-0312
Mailing Address - Street 1:7408 NE 87TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-2827
Mailing Address - Country:US
Mailing Address - Phone:360-989-0312
Mailing Address - Fax:360-567-0620
Practice Address - Street 1:2402 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3229
Practice Address - Country:US
Practice Address - Phone:360-989-0312
Practice Address - Fax:360-567-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA24601261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center