Healthcare Provider Details

I. General information

NPI: 1710648431
Provider Name (Legal Business Name): LOTUS RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825A BIGLEY AVE
CHARLESTON WV
25302-4145
US

IV. Provider business mailing address

PO BOX 8413
SOUTH CHARLESTON WV
25303-0413
US

V. Phone/Fax

Practice location:
  • Phone: 304-946-8270
  • Fax: 833-989-2426
Mailing address:
  • Phone: 304-946-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHELSEA LEIGH CARTER
Title or Position: CLINICAL DIRECTOR
Credential: LICSW
Phone: 304-946-8270