Provider Demographics
NPI:1902407034
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:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOATH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:304-928-5144
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:304-928-5144
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:304-928-5144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1316593270OtherJESSICA TOATH-CALLAHAN
WV1902407034Medicaid
WVDP00945150OtherCHELSEA LEIGH CARTER LICSW