| Lotus Mental Health System Llc | |
|
21604 Dogwood Rd Matteson IL 60443-4400 | |
| (815) 393-9850 | |
| (815) 205-4812 |
| Full Name | Lotus Mental Health System Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 21604 Dogwood Rd, Matteson, Illinois |
| Authorized Official Name and Position | Mikail Bass (OWNER) |
| Authorized Official Contact | 7086464467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lotus Mental Health System Llc 21604 Dogwood Rd Matteson IL 60443-4400 Ph: () - | Lotus Mental Health System Llc 21604 Dogwood Rd Matteson IL 60443-4400 Ph: (815) 393-9850 |
| NPI Number | 1255053526 |
|---|---|
| Provider Enumeration Date | 09/14/2022 |
| Last Update Date | 09/14/2022 |
| Certification Date | 09/11/2022 |
| Medicare PECOS PAC ID | 6305216243 |
|---|---|
| Medicare Enrollment ID | O20230110001971 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255053526 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Mikail Bass |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568924561 PECOS PAC ID: 5799183620 Enrollment ID: I20211007001683 |
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