Healthcare Provider Details

I. General information

NPI: 1538940127
Provider Name (Legal Business Name): ALL CARE AND WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 S BURNSIDE AVE
GONZALES LA
70737-4672
US

IV. Provider business mailing address

2106 S BURNSIDE AVE
GONZALES LA
70737-4672
US

V. Phone/Fax

Practice location:
  • Phone: 225-335-5640
  • Fax:
Mailing address:
  • Phone: 225-335-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. SHAWNDRICK R. REDDING
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 225-449-0102