Healthcare Provider Details

I. General information

NPI: 1598183899
Provider Name (Legal Business Name): BAYOU WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27403 HWY 190 SUITE B
LACOMBE LA
70445
US

IV. Provider business mailing address

27403 HIGHWAY 190 STE B P O BOX 1550
LACOMBE LA
70445-6401
US

V. Phone/Fax

Practice location:
  • Phone: 985-882-7620
  • Fax: 985-882-7622
Mailing address:
  • Phone: 985-882-7620
  • Fax: 985-882-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS LINDA MARIE ANDERSON
Title or Position: OWNER
Credential: N/A
Phone: 985-882-7620