Provider Demographics
NPI:1114658853
Name:THE LOTUS CENTER, INC.
Entity Type:Organization
Organization Name:THE LOTUS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL SPONSOR ED
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:PRISCILLA
Authorized Official - Last Name:CHATELAIN-GRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-284-1803
Mailing Address - Street 1:1401 8TH ST S STE 3
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3658
Mailing Address - Country:US
Mailing Address - Phone:218-284-1803
Mailing Address - Fax:
Practice Address - Street 1:2900 5TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4966
Practice Address - Country:US
Practice Address - Phone:218-284-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LOTUS CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-23
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No347C00000XTransportation ServicesPrivate Vehicle