Provider Demographics
NPI:1043751902
Name:REC ENTERPRISE LLC
Entity Type:Organization
Organization Name:REC ENTERPRISE LLC
Other - Org Name:LIFE OF LOTUS HOLISTIC & WELLNESS PARLOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-807-9810
Mailing Address - Street 1:6040 W LISBON AVE
Mailing Address - Street 2:STE B6
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2116
Mailing Address - Country:US
Mailing Address - Phone:414-488-2808
Mailing Address - Fax:414-488-2854
Practice Address - Street 1:6040 W LISBON AVE
Practice Address - Street 2:STE B6
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2116
Practice Address - Country:US
Practice Address - Phone:414-488-2808
Practice Address - Fax:414-488-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management