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General NPI Number Information
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NPI Number | 1598183899
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Entity Type | Organization
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Legal Business Name | BAYOU WELLNESS CENTER INC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 27403 HWY 190 SUITE B
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City | LACOMBE
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State | LA
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Zip | 70445
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Country | US
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Telephone | 985-882-7620
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Fax | 985-882-7622
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Provider Business Mailing Address
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Address Line | 27403 HIGHWAY 190 STE B P O BOX 1550
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City | LACOMBE
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State | LA
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Zip | 70445-6401
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Country | US
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Telephone | 985-882-7620
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Fax | 985-882-7622
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Authorized Official
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Title or Position | OWNER
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Name | MISS LINDA MARIE ANDERSON
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Credential | N/A
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Telephone | 985-882-7620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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