Jaded Lotus Aba Llc

LBN: Jaded Lotus Aba Llc
Jaded Lotus Aba Llc is an health care organization with primary practice located at 3834 Ginkgo Ln Apt 206 , Memphis TN 38125-6538. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as the primary health care specialty. Jaded Lotus Aba Llc can be contacted via phone (901) 336-4225, or through Fullwiley, Jojuan via phone (901) 498-0108.

Contact Information

Primary practice address
3834 Ginkgo Ln Apt 206 Memphis TN 38125-6538
Phone: (901) 336-4225
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Fullwiley, Jojuan
Phone: (901) 498-0108

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X

Profile Details

NPI number 1023644366
LBN Legal business name Jaded Lotus Aba Llc
DBA Doing business as
Authorized official Fullwiley, Jojuan
Entity Organization
Organization subpart 1 No
Enumeration date Mar 18th, 2020
Last updated Jul 11th, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023644366 NPPES
Other 14404249 CAQH
MEDICAID Q047274 CAQH
MEDICAID Q0565582 CAQH

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