Provider Demographics
NPI:1467850743
Name:NEW ORLEANS EAST WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:NEW ORLEANS EAST WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-363-3334
Mailing Address - Street 1:1500 LAFAYETTE ST
Mailing Address - Street 2:SUITE 141
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5732
Mailing Address - Country:US
Mailing Address - Phone:504-363-3334
Mailing Address - Fax:
Practice Address - Street 1:5640 READ BLVD
Practice Address - Street 2:STE 550
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3140
Practice Address - Country:US
Practice Address - Phone:504-592-6854
Practice Address - Fax:504-592-6845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNERGY WELLNESS SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-18
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4P969BD15Medicare UPIN