Provider Demographics
NPI:1508693185
Name:LILLYS LLC
Entity type:Organization
Organization Name:LILLYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-402-8905
Mailing Address - Street 1:3003 E MICHIGAN AVE # 1235
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4616
Mailing Address - Country:US
Mailing Address - Phone:517-402-8905
Mailing Address - Fax:
Practice Address - Street 1:3110 E HOWE RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9408
Practice Address - Country:US
Practice Address - Phone:517-402-8905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty