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General NPI Number Information
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NPI Number | 1114010667
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Entity Type | Organization
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Legal Business Name | BAKER WELLNESS CENTER ADHC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2402 MAIN STREET
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City | BAKER
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State | LA
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Zip | 70714
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Country | US
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Telephone | 225-778-1567
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Fax | 225-771-1520
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Provider Business Mailing Address
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Address Line | P.O. BOX 668
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City | BAKER
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State | LA
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Zip | 70704
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Country | US
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Telephone | 225-778-1567
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Fax | 225-771-1520
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. RODOLFO M MANALAC
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Credential | M.D.
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Telephone | 225-778-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 2020
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License Number State | LA
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