Healthcare Provider Details

I. General information

NPI: 1225951130
Provider Name (Legal Business Name): LOTUS LODGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 UVALDA ST
AURORA CO
80011-8602
US

IV. Provider business mailing address

22699 E IDA CIR
AURORA CO
80015-6669
US

V. Phone/Fax

Practice location:
  • Phone: 303-551-1610
  • Fax:
Mailing address:
  • Phone: 303-507-3623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GENNADY SHILING
Title or Position: OWNER
Credential: RN
Phone: 303-507-3623