MEDICARE: LOTUS HEALTHCARE PARTNERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	980000959	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HP0276	OTHER	CA	REGIONAL CENTER

General Provider Information

NPI Number	:	1174522700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS HEALTHCARE PARTNERS, INC

Provider Business Mailing Address
First Line	:	402 S PROSPECTORS RD STE G
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1618
Country	:	US
Telephone Number	:	909-396-7440
Fax Number	:	909-396-7488

Provider Business Practice Location Address
First Line	:	402 S PROSPECTORS RD STE G
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1618
Country	:	US
Telephone Number	:	909-396-7440
Fax Number	:	909-396-7488

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOCELYN BUNOAN MANALO
Credential	:	RN, MSN FNP
Telephone Number	:	909-396-7440

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	11/06/2017

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