Provider Demographics
NPI:1174522700
Name:LOTUS HEALTHCARE PARTNERS, INC
Entity type:Organization
Organization Name:LOTUS HEALTHCARE PARTNERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:BUNOAN
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN FNP
Authorized Official - Phone:909-396-7440
Mailing Address - Street 1:402 S PROSPECTORS RD STE G
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1618
Mailing Address - Country:US
Mailing Address - Phone:909-396-7440
Mailing Address - Fax:909-396-7488
Practice Address - Street 1:402 S PROSPECTORS RD STE G
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1618
Practice Address - Country:US
Practice Address - Phone:909-396-7440
Practice Address - Fax:909-396-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000959251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57636FMedicaid
CAHP0276OtherREGIONAL CENTER
CAHHA57636FMedicaid
CAL00007Medicare ID - Type UnspecifiedMEDICARE NHIC PART B