Provider Demographics
NPI:1295480424
Name:LOTUS HOMECARE, LLC
Entity type:Organization
Organization Name:LOTUS HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:LOTANNA
Authorized Official - Last Name:ANYAEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-612-2080
Mailing Address - Street 1:4822 N 133RD PLZ APT 702
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1022
Mailing Address - Country:US
Mailing Address - Phone:402-319-2637
Mailing Address - Fax:
Practice Address - Street 1:4822 N 133RD PLZ APT 702
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1022
Practice Address - Country:US
Practice Address - Phone:402-319-2637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty