Provider Demographics
NPI:1669258067
Name:BLU LOTUS LLC
Entity type:Organization
Organization Name:BLU LOTUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN CCM
Authorized Official - Phone:704-953-2825
Mailing Address - Street 1:1819 SARDIS RD N STE 350
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2472
Mailing Address - Country:US
Mailing Address - Phone:704-755-6333
Mailing Address - Fax:
Practice Address - Street 1:4560 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8476
Practice Address - Country:US
Practice Address - Phone:704-953-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251J00000XAgenciesNursing Care