Active NPI
Leon Lucas
- Community Health Worker
- Livonia, MI
National Provider Identifier
1750700365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 1134203235
- Practice address
- 34050 Industrial Rd
Livonia, MI 48150-1306 - Phone
- (734) 293-0034
- NPI assigned
- Apr 10, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 1134203235 | MI | Primary |
Addresses
Primary practice location
34050 Industrial Rd
Livonia, MI 48150-1306
Mailing address
34050 Industrial Rd
Livonia, MI 48150-1306
Phone (734) 293-0034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1134203235 | MI | MD | Intellectual & Developmental Disabilities Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Domus Vita | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Livonia, MI
- NPI 1134203235
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397088000000",
"number": "1750700365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34050 INDUSTRIAL RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481501306",
"telephone_number": "734-293-0034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34050 INDUSTRIAL RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481501306",
"telephone_number": "734-293-0034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCAS",
"first_name": "LEON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-04-10",
"last_updated": "2014-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "MI",
"license": "1134203235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.