Provider Demographics
NPI:1770046062
Name:ELYSIAN FIELDS TOTAL WELLNESS LLC
Entity Type:Organization
Organization Name:ELYSIAN FIELDS TOTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-284-3866
Mailing Address - Street 1:4301 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3875
Mailing Address - Country:US
Mailing Address - Phone:504-284-3866
Mailing Address - Fax:504-288-4493
Practice Address - Street 1:4301 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3875
Practice Address - Country:US
Practice Address - Phone:504-284-3866
Practice Address - Fax:504-288-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center