Provider Demographics
NPI:1265878805
Name:LEWIS ENRICHMENT ADULT PROGRAM
Entity type:Organization
Organization Name:LEWIS ENRICHMENT ADULT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-509-7143
Mailing Address - Street 1:1050 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1726
Mailing Address - Country:US
Mailing Address - Phone:419-509-7143
Mailing Address - Fax:
Practice Address - Street 1:1050 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1726
Practice Address - Country:US
Practice Address - Phone:419-509-7143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services