Provider Demographics
NPI:1730807579
Name:THE WELL LIFE INTEGRATIVE HEALTH INC
Entity type:Organization
Organization Name:THE WELL LIFE INTEGRATIVE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-298-1667
Mailing Address - Street 1:72240 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-2966
Mailing Address - Country:US
Mailing Address - Phone:985-807-8148
Mailing Address - Fax:
Practice Address - Street 1:72240 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-2966
Practice Address - Country:US
Practice Address - Phone:985-807-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy