Provider Demographics
NPI:1952833477
Name:LEWIS, LAKEASHI
Entity Type:Individual
Prefix:
First Name:LAKEASHI
Middle Name:
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 1:11910 NW 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-2701
Mailing Address - Country:US
Mailing Address - Phone:786-521-4082
Mailing Address - Fax:
Practice Address - Street 1:11910 N.W 19 AVE. #A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL.
Practice Address - Zip Code:33167
Practice Address - Country:UM
Practice Address - Phone:786-521-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL109776311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home