Provider Demographics
NPI:1407128598
Name:FAMILY HEALTH CARE AND WELLNESS CENTER
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CODY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:985-543-6800
Mailing Address - Street 1:2511 HIGHWAY 190 E
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-8510
Mailing Address - Country:US
Mailing Address - Phone:985-543-6800
Mailing Address - Fax:985-543-6801
Practice Address - Street 1:2511 HIGHWAY 190 E
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-8510
Practice Address - Country:US
Practice Address - Phone:985-543-6800
Practice Address - Fax:985-543-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
LAAP 04596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1456241Medicaid