MEDICARE: LOTUS HOSPICE 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1457187569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS HOSPICE LLC

Provider Business Mailing Address
First Line	:	4711 W 4365 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-4915
Country	:	US
Telephone Number	:	801-699-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	4711 W 4365 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-4915
Country	:	US
Telephone Number	:	801-699-2050
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BETHANY ROLLINS
Credential	:
Telephone Number	:	801-699-2050

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	09/13/2024

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Directions to “LOTUS HOSPICE LLC ” Practice Location

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