Provider Demographics
NPI:1447988803
Name:BLEU LOTUS 360 LLC
Entity type:Organization
Organization Name:BLEU LOTUS 360 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MS
Authorized Official - First Name:MACHADA
Authorized Official - Middle Name:ALLAYNA
Authorized Official - Last Name:CURETON
Authorized Official - Suffix:
Authorized Official - Credentials:MACHADA CURETON
Authorized Official - Phone:773-739-6024
Mailing Address - Street 1:122 S MICHIGAN AVE STE 1390
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6036
Mailing Address - Country:US
Mailing Address - Phone:773-739-6024
Mailing Address - Fax:
Practice Address - Street 1:1600 N STATE ROUTE 50 STE 726
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9314
Practice Address - Country:US
Practice Address - Phone:815-585-6669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center