Healthcare Provider Details

I. General information

NPI: 1548080641
Provider Name (Legal Business Name): LOTUS ADULT DAY HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ALLSTON ST APT 1
REVERE MA
02151-5271
US

IV. Provider business mailing address

14 ALLSTON ST APT 1
REVERE MA
02151-5271
US

V. Phone/Fax

Practice location:
  • Phone: 781-690-6797
  • Fax:
Mailing address:
  • Phone: 781-690-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE AGUILAR
Title or Position: CO-OWNER/MEMBER
Credential: FNP-C
Phone: 781-690-6797