Healthcare Provider Details

I. General information

NPI: 1205760543
Provider Name (Legal Business Name): LOTUS ADDICTION RECOVERY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 ELM ST STE 204
MANCHESTER NH
03101-2130
US

IV. Provider business mailing address

814 ELM ST STE 204
MANCHESTER NH
03101-2130
US

V. Phone/Fax

Practice location:
  • Phone: 401-405-1840
  • Fax:
Mailing address:
  • Phone: 508-361-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIVANI PEREIRA
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 508-361-1996