Provider Demographics
NPI:1275269946
Name:HAVLIK HEALTH LLC
Entity Type:Organization
Organization Name:HAVLIK HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HAVLIK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:337-501-3934
Mailing Address - Street 1:501 TORRENOVA CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-1834
Mailing Address - Country:US
Mailing Address - Phone:337-573-2031
Mailing Address - Fax:337-270-2674
Practice Address - Street 1:117 CAILLOUET PL STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7807
Practice Address - Country:US
Practice Address - Phone:337-573-2031
Practice Address - Fax:337-270-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty