Healthcare Provider Details

I. General information

NPI: 1285414433
Provider Name (Legal Business Name): LOTUS COMMUNITY LIVING SUPPORTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 BRIDLE PATH
FLINT MI
48507-1201
US

IV. Provider business mailing address

481 N MAIN ST STE 208
FRANKENMUTH MI
48734-1115
US

V. Phone/Fax

Practice location:
  • Phone: 810-337-1275
  • Fax:
Mailing address:
  • Phone: 810-689-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: EURICE PAIGE
Title or Position: EXCUTIVE DIRECTOR
Credential:
Phone: 810-689-2935