Provider Demographics
NPI:1700401643
Name:LOTUS HEALTH & COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:LOTUS HEALTH & COUNSELING CENTER LLC
Other - Org Name:LOTUS HEALTH & COUNSELING CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIURYS
Authorized Official - Middle Name:
Authorized Official - Last Name:REGALON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-574-0261
Mailing Address - Street 1:13727 SW 152ND ST STE 931
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1106
Mailing Address - Country:US
Mailing Address - Phone:786-800-1093
Mailing Address - Fax:786-401-7881
Practice Address - Street 1:8500 SW 92ND ST STE 106B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7379
Practice Address - Country:US
Practice Address - Phone:305-720-6118
Practice Address - Fax:786-401-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL---------Medicaid
FL-------OtherAHCA LICENSE