MEDICARE: LOTUS PEACE MASSAGE, LLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1184462830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS PEACE MASSAGE, LLC

Provider Business Mailing Address
First Line	:	8072 SILVER FOX WAY CHESAPEAKE
Second Line	:
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732
Country	:	US
Telephone Number	:	202-867-3114
Fax Number	:

Provider Business Practice Location Address
First Line	:	9120 CHESAPEAKE AVE STE 202
Second Line	:
City	:	NORTH BEACH
State	:	MD
Zip	:	20714-5043
Country	:	US
Telephone Number	:	240-718-6055
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATRICE MCALLISTER
Credential	:
Telephone Number	:	240-718-6055

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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