Organization
LAKE WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE ROUSSEL (OWNER)
(337) 703-0880
Entity
Organization
Contact information
Practice address
7434 PICARDY AVE STE A&B, BATON ROUGE, LA 70808-7204
(225) 470-5253
(225) 900-7474
Mailing address
501 W SAINT MARY BLVD STE 308, LAFAYETTE, LA 70506-4600
(337) 703-0880
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
03/01/2019
Last updated
03/01/2019
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