Provider Demographics
NPI:1669286381
Name:LOTUS ASSISTED LIVING FACILITY LLC
Entity type:Organization
Organization Name:LOTUS ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-409-4727
Mailing Address - Street 1:2021 DONKER DR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-8828
Mailing Address - Country:US
Mailing Address - Phone:407-409-4727
Mailing Address - Fax:
Practice Address - Street 1:4704 WHISTLER DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5120
Practice Address - Country:US
Practice Address - Phone:407-409-4727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility