# LOTUS MOON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lotus Moon
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295339166
- **Authorized official:** PESEY M KUOCH (OWNER)
- **Authorized official phone:** (612) 535-7292

## Contact information

- **Practice address:** 14667 LAKE STREET EXT, MINNETONKA, MN 55345-2926
- **Practice address phone:** (612) 584-0917
- **Mailing address:** 15401 LAKE STREET EXT, MINNETONKA, MN 55345-1914
- **Mailing address phone:** (612) 535-7292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174200000X | Meals Provider | — | NULL | — |
| 177F00000X | Lodging Provider | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/22/2020
- **Last updated:** 11/22/2020