Organization
LOTUS RECOVERY CENTER LLC
Active
Organization
LOTUS RECOVERY CENTER LLC
Active
Other names
Road to Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ANN TOATH FNP-C (MEDICAL DIRECTOR)
(304) 928-5144
Entity
Organization
Contact information
Practice address
4202 MALDEN DR, MALDEN, WV 25306-6442
(304) 928-5144
Mailing address
PO BOX 8413, SOUTH CHARLESTON, WV 25303-0413
(304) 928-5144
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316593270
JESSICA TOATH-CALLAHAN
WV
05
—
1902407034
—
WV
01
—
DP00945150
CHELSEA LEIGH CARTER LICSW
WV
Enumeration date
11/04/2020
Last updated
07/28/2023
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