Healthcare Provider Details

I. General information

NPI: 1710630926
Provider Name (Legal Business Name): LOTUS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 SUNFISH LAKE BLVD NW STE 206
RAMSEY MN
55303-4760
US

IV. Provider business mailing address

19971 FEBRUARY ST
BIG LAKE MN
55309-4800
US

V. Phone/Fax

Practice location:
  • Phone: 224-622-3408
  • Fax:
Mailing address:
  • Phone: 651-280-7702
  • Fax: 612-435-0262

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
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ALOYS PAGAL ONGLA
Title or Position: CO-OWNER
Credential:
Phone: 651-280-7702