MEDICARE: LOTUS RECOVERY REHAB

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		FL

General Provider Information

NPI Number	:	1700153798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS RECOVERY REHAB

Provider Business Mailing Address
First Line	:	4200 NE 22ND AVE
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7318
Country	:	US
Telephone Number	:	954-588-7039
Fax Number	:	561-455-4609

Provider Business Practice Location Address
First Line	:	4200 NE 22ND AVENUE
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064
Country	:	US
Telephone Number	:	954-588-7039
Fax Number	:	561-455-4609

Authorized Official
Title or Position	:	CEO
Name	:	RENEE STIFF
Credential	:
Telephone Number	:	954-588-7039

Provider Enumeration Date	:	11/19/2011
Last Update Date	:	11/19/2011

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Directions to “LOTUS RECOVERY REHAB ” Practice Location

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