Provider Demographics
NPI:1295311488
Name:ST JOHN OF LOTUS HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:ST JOHN OF LOTUS HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEJULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMBUI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:929-410-7023
Mailing Address - Street 1:218 STUYVESANT AVE , SUITE #4 SECOND FLOOR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071
Mailing Address - Country:US
Mailing Address - Phone:929-410-7023
Mailing Address - Fax:
Practice Address - Street 1:218 STUYVESANT AVE , SUITE #4 SECOND FLOOR
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071
Practice Address - Country:US
Practice Address - Phone:973-410-7023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine