Provider Demographics
NPI:1275419350
Name:LOLITA LLC
Entity type:Organization
Organization Name:LOLITA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIGHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-484-1459
Mailing Address - Street 1:4420 N SONOMA RANCH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7342
Mailing Address - Country:US
Mailing Address - Phone:575-642-5800
Mailing Address - Fax:
Practice Address - Street 1:5355 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:219-756-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty