MEDICARE: LAKE WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1518424258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 53038
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-3038
Country	:	US
Telephone Number	:	888-488-5253
Fax Number	:

Provider Business Practice Location Address
First Line	:	4330 LOVELAND ST STE A
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-4179
Country	:	US
Telephone Number	:	504-736-5253
Fax Number	:	504-676-5252

Authorized Official
Title or Position	:	OWNER
Name	:	ROY VIGER
Credential	:
Telephone Number	:	888-488-5253

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	11/13/2025

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Directions to “LAKE WELLNESS CENTER, LLC ” Practice Location

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