Provider Demographics
NPI:1407970510
Name:COMPREHENSIVE WELLNESS CENTER INC
Entity Type:Organization
Organization Name:COMPREHENSIVE WELLNESS CENTER INC
Other - Org Name:COMPREHENSIVE WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURKHALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-523-4103
Mailing Address - Street 1:1400 ESPLANADE AVE
Mailing Address - Street 2:1707 ELYSIAN FIELDS AVENUE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-1803
Mailing Address - Country:US
Mailing Address - Phone:504-523-4103
Mailing Address - Fax:504-523-5910
Practice Address - Street 1:1400 ESPLANADE AVE
Practice Address - Street 2:1707 ELYSIAN FIELDS AVE
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-1803
Practice Address - Country:US
Practice Address - Phone:504-523-4103
Practice Address - Fax:504-523-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty