Provider Demographics
NPI:1285458976
Name:LOTUS ASSISTED LIVING FACILITY INC
Entity type:Organization
Organization Name:LOTUS ASSISTED LIVING FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-628-0832
Mailing Address - Street 1:4077 MANOR FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-8850
Mailing Address - Country:US
Mailing Address - Phone:561-628-0832
Mailing Address - Fax:
Practice Address - Street 1:1477 SW GOODMAN AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-1418
Practice Address - Country:US
Practice Address - Phone:561-628-0832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility