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General NPI Number Information
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NPI Number | 1841733789
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Entity Type | Organization
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Legal Business Name | LOTUS PEER RECOVERY LLC
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Dates
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Enumeration Date | 11/27/2016
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Last Update Date | 11/27/2016
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Provider Practice Location Address
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Address Line | 112 CRESCENT DR
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City | KERRVILLE
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State | TX
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Zip | 78028-3002
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Country | US
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Telephone | 830-481-7406
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Fax | 830-326-6469
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Provider Business Mailing Address
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Address Line | 112 CRESCENT DR
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City | KERRVILLE
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State | TX
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Zip | 78028-3002
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Country | US
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Telephone | 830-481-7406
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Fax | 830-326-6469
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CATHERINE NICOLE SAURAGE
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Credential | PRSS
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Telephone | 830-481-7406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 12070513
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License Number State | TX
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