Provider Demographics
NPI:1598183899
Name:BAYOU WELLNESS CENTER INC
Entity Type:Organization
Organization Name:BAYOU WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:985-882-7620
Mailing Address - Street 1:27403 HIGHWAY 190 STE B
Mailing Address - Street 2:P O BOX 1550
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-6401
Mailing Address - Country:US
Mailing Address - Phone:985-882-7620
Mailing Address - Fax:985-882-7622
Practice Address - Street 1:27403 HWY 190
Practice Address - Street 2:SUITE B
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445
Practice Address - Country:US
Practice Address - Phone:985-882-7620
Practice Address - Fax:985-882-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health