Provider Demographics
NPI:1821795337
Name:THE LOUISIANA CENTER FOR HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:THE LOUISIANA CENTER FOR HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:225-924-4550
Mailing Address - Street 1:4520 S SHERWOOD FOREST BLVD STE 104-396
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6400
Mailing Address - Country:US
Mailing Address - Phone:225-924-4550
Mailing Address - Fax:225-435-2735
Practice Address - Street 1:3554 PLANK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-6579
Practice Address - Country:US
Practice Address - Phone:225-924-4550
Practice Address - Fax:225-435-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty