LAKE WELLNESS CENTER, LLC (NPI# 1528525268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528525268 |
| Entity Type | Organization |
| Organization Name | LAKE WELLNESS CENTER, LLC |
| Practice Address |
4540 Ambassador Caffery Pkwy Ste C110 Lafayette LA 70508-6937 |
| Mailing Address |
501 W Saint Mary Blvd Ste 308 Lafayette LA 70506-4600 |
| Practice Telephone | 3373465253 |
| Practice Fax Number | 3377030707 |
| Mailing Telephone | 3377030880 |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2019-03-01 |
| Authorized Official Name | GEORGE ROUSSEL (OWNER) |
| Authorized Official Telephone | 3377030880 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518424258 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 4330 Loveland St Ste A, Metairie, LA 70006-4179 | 2019-03-01 |
| 1346707080 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 7434 Picardy Ave Ste A&b, Baton Rouge, LA 70808-7204 | 2019-03-01 |
| 1740824507 | Lake Wellness Center, LLC | Clinic/Center | 13100 River Rd, Destrehan, LA 70047-5219 | 2019-11-04 |
| 1790242436 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 19411 Helenbirg Rd Ste 101, Covington, LA 70433-5199 | 2019-03-01 |
| 1164989802 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 3620 Chestnut St, New Orleans, LA 70115-3615 | 2019-03-01 |
| 1982161626 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 1340 W Tunnel Blvd Ste 212, Houma, LA 70360-2818 | 2019-03-01 |
| 1255898995 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 635a Petro Point Dr, Lake Charles, LA 70607-7054 | 2019-03-01 |
| Street Address |
4540 AMBASSADOR CAFFERY PKWY STE C110 |
| City | LAFAYETTE |
| State | LA |
| Zip Code | 70508-6937 |
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| 1780218727 | Jennifer Trumps | Case Manager/Care Coordinator | 200 Entergy Parkway, Lafayette, LA 70508 | 2020-02-28 |
| 1740749605 | Hunter Sy Arceneaux | Physical Therapist | 1700 Kaliste Saloom Road, Building 3, Suite 300, Lafayette, LA 70508 | 2019-03-19 |
| 1295292787 | Brad Michael Gros | Counselor | 160 South Beadle Road, Lafayette, LA 70508 | 2019-02-21 |
| 1205337581 | Alternative Perspectives, LLC | Clinic/Center | 2807 Kaliste Saloom Rd Ste B, Lafayette, LA 70508 | 2018-02-22 |
| 1124528807 | Zachariah James Hebert | Counselor | 1602 W Pinhook Rd Suite 100a, The Family Tree, Lafayette, LA 70508 | 2018-02-19 |
| 1164934477 | Ilyas Munshi, Md Apmc | Non-Pharmacy Dispensing Site | 99 W. Martial Ave, Lafayette, LA 70508 | 2017-10-26 |
| 1447761226 | Louisiana Orthopaedic Specialists, LLC | Durable Medical Equipment & Medical Supplies | 4231 Ambassador Caffery Pkwy, Suite 102, Lafayette, LA 70508 | 2017-10-19 |
| 1306365457 | Mk Dixon Counseling and Consulting | Counselor | 105 Industrial Parkway, Lafayette, LA 70508 | 2017-09-10 |
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| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.