Provider Demographics
NPI:1700153798
Name:LOTUS RECOVERY REHAB
Entity Type:Organization
Organization Name:LOTUS RECOVERY REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:4200 NE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7318
Mailing Address - Country:US
Mailing Address - Phone:954-588-7039
Mailing Address - Fax:561-455-4609
Practice Address - Street 1:4200 NE 22ND AVENUE
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-588-7039
Practice Address - Fax:561-455-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder