Healthcare Provider Details

I. General information

NPI: 1508629122
Provider Name (Legal Business Name): WELLSPRING WOUND CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 AMBASSADOR CAFFERY PKWY STE 520
LAFAYETTE LA
70503-5268
US

IV. Provider business mailing address

4023 AMBASSADOR CAFFERY PKWY STE 520
LAFAYETTE LA
70503-5268
US

V. Phone/Fax

Practice location:
  • Phone: 337-568-4325
  • Fax: 337-446-8776
Mailing address:
  • Phone: 337-568-4325
  • Fax: 337-446-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD CARL RAINEY
Title or Position: PRESIDENT/COO
Credential:
Phone: 337-278-5605