Organization
LOTUS MOON, LLC
Active
Other names
Lotus Moon
Organization subpart
No
Provider details
NPI number
Authorized official
PESEY M KUOCH (OWNER)
(612) 535-7292
Entity
Organization
Contact information
Practice address
14667 LAKE STREET EXT, MINNETONKA, MN 55345-2926
(612) 584-0917
Mailing address
15401 LAKE STREET EXT, MINNETONKA, MN 55345-1914
(612) 535-7292
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
11/22/2020
Last updated
11/22/2020
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