Provider Demographics
NPI:1346577269
Name:LOTUS HOME HEALTH AGENCY OF SOUTHERN NEW MEXICO
Entity Type:Organization
Organization Name:LOTUS HOME HEALTH AGENCY OF SOUTHERN NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SELIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:575-993-1613
Mailing Address - Street 1:4221 VENETIAN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4126
Mailing Address - Country:US
Mailing Address - Phone:575-993-1613
Mailing Address - Fax:575-521-4574
Practice Address - Street 1:4221 VENETIAN LOOP
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4126
Practice Address - Country:US
Practice Address - Phone:575-993-1613
Practice Address - Fax:575-521-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3305251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health