Basic Information
| Provider Information | |||||||||
| NPI: | 1407323264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE LOTUS CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 8TH ST S STE 3 | ||||||||
| Address2: | |||||||||
| City: | MOORHEAD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565603658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182841803 | ||||||||
| FaxNumber: | 2186005484 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 5TH ST S STE 105 | ||||||||
| Address2: | |||||||||
| City: | MOORHEAD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565602768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182841800 | ||||||||
| FaxNumber: | 2182841801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2018 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHATELAIN-GRESS | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
| AuthorizedOfficialMiddleName: | PRISCILLA | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2182841800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LSW | ||||||||
| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 177F00000X | N | Other Service Providers | Lodging | 251B00000X | N | Agencies | Case Management | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 1478390 | 05 | ND | MEDICAID | 1090378 | 05 | MN | MEDICAID |