Provider Demographics
NPI:1538938055
Name:LOTUS RECOVERY SERVICES INC
Entity type:Organization
Organization Name:LOTUS RECOVERY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SHIREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-519-8334
Mailing Address - Street 1:509 MARIN ST STE 123
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4230
Mailing Address - Country:US
Mailing Address - Phone:805-371-6377
Mailing Address - Fax:
Practice Address - Street 1:509 MARIN ST STE 123
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4230
Practice Address - Country:US
Practice Address - Phone:805-371-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOTUS RECOVERY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health