Provider Demographics
NPI:1255041109
Name:LOTUS BEHAVIORAL HEALTH AND REHABILITATIVE SERVICES INC
Entity type:Organization
Organization Name:LOTUS BEHAVIORAL HEALTH AND REHABILITATIVE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:NEFERTITI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMENRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-298-3770
Mailing Address - Street 1:2121 E FLAMINGO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5123
Mailing Address - Country:US
Mailing Address - Phone:215-298-3770
Mailing Address - Fax:
Practice Address - Street 1:2121 E FLAMINGO RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5123
Practice Address - Country:US
Practice Address - Phone:215-298-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)