Provider Demographics
NPI:1831529148
Name:RED LOTUS WELLNESS CENTER LLC
Entity type:Organization
Organization Name:RED LOTUS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALITE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-770-1850
Mailing Address - Street 1:20 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:VT
Mailing Address - Zip Code:05765-1325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 ALLEN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4776
Practice Address - Country:US
Practice Address - Phone:802-770-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0000164171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty