Provider Demographics
NPI:1659080141
Name:LOTUS WELLNESS, LLC
Entity Type:Organization
Organization Name:LOTUS WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWAN-BOROWY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW
Authorized Official - Phone:401-285-0633
Mailing Address - Street 1:61 BOYDEN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2586
Mailing Address - Country:US
Mailing Address - Phone:401-285-0633
Mailing Address - Fax:
Practice Address - Street 1:61 BOYDEN RD STE 5
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-2586
Practice Address - Country:US
Practice Address - Phone:401-285-0633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1174880819OtherNPI