Provider Demographics
NPI:1346545449
Name:BLUE LOTUS HEALING ARTS, LLC
Entity Type:Organization
Organization Name:BLUE LOTUS HEALING ARTS, LLC
Other - Org Name:EASTERN SHORE NATURAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:HERSCHEL
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:612-590-1443
Mailing Address - Street 1:2720 E 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1337
Mailing Address - Country:US
Mailing Address - Phone:612-721-0036
Mailing Address - Fax:
Practice Address - Street 1:2720 E 50TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1337
Practice Address - Country:US
Practice Address - Phone:612-721-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1518171100000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty