MEDICARE: LOTUS BLOSSOM HOSPICE AND PALLIATIVE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1710573639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS BLOSSOM HOSPICE AND PALLIATIVE CARE LLC

Provider Business Mailing Address
First Line	:	6065 ROSWELL RD STE 510
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4015
Country	:	US
Telephone Number	:	404-386-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	6065 ROSWELL RD STE 510
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4015
Country	:	US
Telephone Number	:	404-386-2005
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SUSAN BETANCOURT TABA
Credential	:
Telephone Number	:	404-386-2005

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	12/15/2020

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