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General NPI Number Information
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NPI Number | 1770012007
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Entity Type | Organization
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Legal Business Name | LOTUS HOUSE RECOVERY CENTER LLC
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12357 W DIXIE HWY
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5428
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Country | US
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Telephone | 917-596-1929
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Fax |
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Provider Business Mailing Address
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Address Line | 12357 W DIXIE HWY
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5428
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Country | US
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Telephone | 917-596-1929
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ED TICHELI
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Credential |
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Telephone | 917-596-1929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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