Healthcare Provider Details

I. General information

NPI: 1245106871
Provider Name (Legal Business Name): LOTUS WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W 10TH ST
WILMINGTON DE
19801-1424
US

IV. Provider business mailing address

1812 NEWPORT GAP PIKE
WILMINGTON DE
19808-6179
US

V. Phone/Fax

Practice location:
  • Phone: 302-500-5991
  • Fax:
Mailing address:
  • Phone: 302-500-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JEAN TIMMONS
Title or Position: CHIEF OF COMPLIANCE
Credential: RN, BSN
Phone: 302-500-5997