Provider Demographics
NPI:1952113243
Name:LEWIS LEGACY OF LOVE
Entity type:Organization
Organization Name:LEWIS LEGACY OF LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEWISHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCVAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-478-0992
Mailing Address - Street 1:10371 LANARK ST # A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1230
Mailing Address - Country:US
Mailing Address - Phone:313-478-0992
Mailing Address - Fax:
Practice Address - Street 1:10371 LANARK ST # A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1230
Practice Address - Country:US
Practice Address - Phone:313-478-0992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care