Provider Demographics
NPI:1568216356
Name:WHITE LOTUS LANDING, LLC
Entity Type:Organization
Organization Name:WHITE LOTUS LANDING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-401-1511
Mailing Address - Street 1:58 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3108
Mailing Address - Country:US
Mailing Address - Phone:978-883-6333
Mailing Address - Fax:
Practice Address - Street 1:58 GROVE AVE
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3108
Practice Address - Country:US
Practice Address - Phone:978-883-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility