MEDICARE: LOTUS ASSISTED LIVING FACILITY 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1669286381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS ASSISTED LIVING FACILITY LLC

Provider Business Mailing Address
First Line	:	2021 DONKER DR
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-8828
Country	:	US
Telephone Number	:	407-409-4727
Fax Number	:

Provider Business Practice Location Address
First Line	:	4704 WHISTLER DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5120
Country	:	US
Telephone Number	:	407-409-4727
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HARRY MAUGE
Credential	:
Telephone Number	:	407-409-4727

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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