Provider Demographics
NPI:1780633602
Name:SOUTHERN WELLNESS PHS LLC
Entity Type:Organization
Organization Name:SOUTHERN WELLNESS PHS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-227-0461
Mailing Address - Street 1:3712 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6802
Mailing Address - Country:US
Mailing Address - Phone:504-227-0461
Mailing Address - Fax:504-227-8398
Practice Address - Street 1:3712 MACARTHUR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6802
Practice Address - Country:US
Practice Address - Phone:504-227-0461
Practice Address - Fax:504-227-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital