Healthcare Provider Details

I. General information

NPI: 1972421469
Provider Name (Legal Business Name): LOTUS BLUM USA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 MAIN ST STE 6
DOWNERS GROVE IL
60516-3455
US

IV. Provider business mailing address

6900 MAIN ST STE 6
DOWNERS GROVE IL
60516-3455
US

V. Phone/Fax

Practice location:
  • Phone: 630-822-4295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: FIZZA PENWALA
Title or Position: DIRECTOR
Credential:
Phone: 321-315-4665