Provider Demographics
NPI:1700124179
Name:LOTUS RECOVERY REHAB, LLC
Entity Type:Organization
Organization Name:LOTUS RECOVERY REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-588-7039
Mailing Address - Street 1:455 NE 5TH AVE
Mailing Address - Street 2:D-117
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5658
Mailing Address - Country:US
Mailing Address - Phone:954-588-4934
Mailing Address - Fax:865-984-2426
Practice Address - Street 1:955 NW 17TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2516
Practice Address - Country:US
Practice Address - Phone:954-588-4934
Practice Address - Fax:865-984-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-19
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2039197OtherCLIA