Provider Demographics
NPI:1588061774
Name:LOUISIANA WELLNESS PARTNERS, LLC
Entity type:Organization
Organization Name:LOUISIANA WELLNESS PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WORDSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-451-2331
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-1527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:626 VEROT SCHOOL RD
Practice Address - Street 2:SUITE H
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5094
Practice Address - Country:US
Practice Address - Phone:337-366-1163
Practice Address - Fax:337-504-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine