Healthcare Provider Details

I. General information

NPI: 1275270639
Provider Name (Legal Business Name): LOTUS LIFE LINE TRAINING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 NW 99TH ST
MIAMI FL
33147-1807
US

IV. Provider business mailing address

2114 N FLAMINGO RD # 308
PEMBROKE PINES FL
33028-3501
US

V. Phone/Fax

Practice location:
  • Phone: 954-477-9727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CANDACE CLARK
Title or Position: OWNER
Credential:
Phone: 954-418-2036