Healthcare Provider Details

I. General information

NPI: 1295480424
Provider Name (Legal Business Name): LOTUS HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 N 133RD PLZ APT 702
OMAHA NE
68164-1022
US

IV. Provider business mailing address

4822 N 133RD PLZ APT 702
OMAHA NE
68164-1022
US

V. Phone/Fax

Practice location:
  • Phone: 402-319-2637
  • Fax:
Mailing address:
  • Phone: 402-319-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TREVOR LOTANNA ANYAEGBU
Title or Position: CEO
Credential: RN
Phone: 402-612-2080