Provider Demographics
NPI:1124352141
Name:BODHI LOTUS, INC
Entity type:Organization
Organization Name:BODHI LOTUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:NEWKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:585-797-5259
Mailing Address - Street 1:61 MARSHALL ST
Mailing Address - Street 2:#1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3523
Mailing Address - Country:US
Mailing Address - Phone:585-797-5259
Mailing Address - Fax:
Practice Address - Street 1:61 MARSHALL ST
Practice Address - Street 2:#1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3523
Practice Address - Country:US
Practice Address - Phone:585-797-5259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty