Provider Demographics
NPI:1841733789
Name:LOTUS PEER RECOVERY LLC
Entity type:Organization
Organization Name:LOTUS PEER RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SAURAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PRSS
Authorized Official - Phone:830-481-7406
Mailing Address - Street 1:112 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3002
Mailing Address - Country:US
Mailing Address - Phone:830-481-7406
Mailing Address - Fax:830-326-6469
Practice Address - Street 1:112 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3002
Practice Address - Country:US
Practice Address - Phone:830-481-7406
Practice Address - Fax:830-326-6469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOTUS PEER RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-27
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12070513251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health