Healthcare Provider Details

I. General information

NPI: 1770795825
Provider Name (Legal Business Name): CAMBRIDGE HOLISTIC WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 HWY 1042
GREENSBURG LA
70441
US

IV. Provider business mailing address

PO BOX 52710
BATON ROUGE LA
70892
US

V. Phone/Fax

Practice location:
  • Phone: 225-222-3008
  • Fax: 225-222-4357
Mailing address:
  • Phone: 225-222-3008
  • Fax: 225-222-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberADHC2678
License Number StateLA

VIII. Authorized Official

Name: ASHTON SPEARS
Title or Position: BILLING AGENT
Credential:
Phone: 225-505-3285