Provider Demographics
NPI:1598475600
Name:RISING LOTUS RECOVERY LLC
Entity Type:Organization
Organization Name:RISING LOTUS RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-983-7753
Mailing Address - Street 1:7701 AMPERE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1904
Mailing Address - Country:US
Mailing Address - Phone:445-300-8877
Mailing Address - Fax:
Practice Address - Street 1:7701 AMPERE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1904
Practice Address - Country:US
Practice Address - Phone:445-300-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility