Provider Demographics
NPI:1336333277
Name:DISCOVER WELLNESS & REHAB OF ELMWOOD, LLC
Entity type:Organization
Organization Name:DISCOVER WELLNESS & REHAB OF ELMWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ARGUE
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:504-818-3800
Mailing Address - Street 1:5608 CITRUS BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5517
Mailing Address - Country:US
Mailing Address - Phone:504-818-3800
Mailing Address - Fax:909-752-4187
Practice Address - Street 1:5608 CITRUS BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5517
Practice Address - Country:US
Practice Address - Phone:504-818-3800
Practice Address - Fax:909-752-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA994261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DC21Medicare PIN