# POWELL'S PRECIOUS LOTUS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376318931
- **Authorized official:** KIM POWELL (OWNER/PRESIDENT)
- **Authorized official phone:** (574) 387-9160

## Contact information

- **Practice address:** 5316 REO AVE, SOUTH BEND, IN 46619-1341
- **Practice address phone:** (574) 440-1731
- **Mailing address:** 5316 REO AVE, SOUTH BEND, IN 46619-1341
- **Mailing address phone:** (574) 387-9160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 11/22/2023
- **Last updated:** 09/24/2024