| Rising Lotus Healing Llc | |
|
320 N Leroux St Ste C Flagstaff AZ 86001-4535 | |
| (928) 550-8002 | |
| (520) 305-4304 |
| Full Name | Rising Lotus Healing Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 320 N Leroux St Ste C, Flagstaff, Arizona |
| Authorized Official Name and Position | Stephen Taylor (MANAGER) |
| Authorized Official Contact | 9284572727 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rising Lotus Healing Llc Po Box 1324 Flagstaff AZ 86002-1324 Ph: (928) 550-8002 | Rising Lotus Healing Llc 320 N Leroux St Ste C Flagstaff AZ 86001-4535 Ph: (928) 550-8002 |
| NPI Number | 1700356409 |
|---|---|
| Provider Enumeration Date | 11/26/2018 |
| Last Update Date | 06/25/2020 |
| Certification Date | 06/25/2020 |
| Medicare PECOS PAC ID | 9537595129 |
|---|---|
| Medicare Enrollment ID | O20200129002522 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700356409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Steven Evan Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750864252 PECOS PAC ID: 1254685795 Enrollment ID: I20191104000979 |
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