Provider Demographics
NPI:1134640196
Name:COMPREHENSIVE WELLNESS GROUP
Entity Type:Organization
Organization Name:COMPREHENSIVE WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:MS
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:CHILTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:225-571-3185
Mailing Address - Street 1:5213 E HUNTERS CHAPEL CT APT A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-9200
Mailing Address - Country:US
Mailing Address - Phone:225-571-3185
Mailing Address - Fax:
Practice Address - Street 1:3875 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3840
Practice Address - Country:US
Practice Address - Phone:225-344-6044
Practice Address - Fax:225-344-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)