Provider Demographics
NPI:1730407966
Name:LOUISIANA COMMUNITY HEALTH AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:LOUISIANA COMMUNITY HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:EBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-638-8878
Mailing Address - Street 1:805 PARENT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760-2215
Mailing Address - Country:US
Mailing Address - Phone:225-638-8878
Mailing Address - Fax:225-638-8879
Practice Address - Street 1:805 PARENT ST
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2215
Practice Address - Country:US
Practice Address - Phone:225-638-8878
Practice Address - Fax:225-638-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
283Q00000X
LA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No283Q00000XHospitalsPsychiatric Hospital