Provider Demographics
NPI:1710648431
Name:LOTUS RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:LOTUS RECOVERY CENTER LLC
Other - Org Name:ROAD TO WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-946-8270
Mailing Address - Street 1:PO BOX 8413
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-0413
Mailing Address - Country:US
Mailing Address - Phone:304-946-8270
Mailing Address - Fax:
Practice Address - Street 1:4202 MALDEN DR
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:WV
Practice Address - Zip Code:25306-6442
Practice Address - Country:US
Practice Address - Phone:304-946-8270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty