Healthcare Provider Details

I. General information

NPI: 1780251843
Provider Name (Legal Business Name): LOTUS RECOVERY CENTER OF COMFORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 DEANNA STREET
COMFORT WV
25049
US

IV. Provider business mailing address

1000 N WEST ST STE 1200
WILMINGTON DE
19801-1058
US

V. Phone/Fax

Practice location:
  • Phone: 302-295-4885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEAN TIMMONS
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 443-844-6040