Provider Demographics
NPI:1184052789
Name:CENTRAL LA. FAMILY HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:CENTRAL LA. FAMILY HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-441-2220
Mailing Address - Street 1:3516 NORTH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3613
Mailing Address - Country:US
Mailing Address - Phone:318-441-2220
Mailing Address - Fax:318-441-2205
Practice Address - Street 1:3516 NORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3613
Practice Address - Country:US
Practice Address - Phone:318-441-2220
Practice Address - Fax:318-441-2205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAPIDES NURSING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD13101R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1366452807OtherNPPES