Healthcare Provider Details

I. General information

NPI: 1346644606
Provider Name (Legal Business Name): ELITE MEDICAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 HODGES ST
LAKE CHARLES LA
70601-7368
US

IV. Provider business mailing address

2802 HODGES ST
LAKE CHARLES LA
70601-7368
US

V. Phone/Fax

Practice location:
  • Phone: 337-419-1873
  • Fax: 337-656-2848
Mailing address:
  • Phone: 337-419-1873
  • Fax: 337-656-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PATRICK HAYES
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 337-419-1873