Healthcare Provider Details

I. General information

NPI: 1184415622
Provider Name (Legal Business Name): LOTUS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4376 S 700 E STE 200
SALT LAKE CITY UT
84107-3077
US

IV. Provider business mailing address

4376 S 700 E STE 200
SALT LAKE CITY UT
84107-3077
US

V. Phone/Fax

Practice location:
  • Phone: 385-272-4292
  • Fax: 866-855-3582
Mailing address:
  • Phone: 385-272-4292
  • Fax: 866-855-3582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA PHYLLIS WASEK
Title or Position: OWNER
Credential: NP
Phone: 385-272-4292