1134522212 NPI number — PREMIER WELLNESS ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134522212 NPI number — PREMIER WELLNESS ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER WELLNESS ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134522212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4727 W PARK DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ZACHARY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70791-4090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-286-4360
Provider Business Mailing Address Fax Number:
225-286-4363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4444 GROOM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70714-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-774-9134
Provider Business Practice Location Address Fax Number:
225-774-9136
Provider Enumeration Date:
10/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BEEHARILAL
Authorized Official First Name:
PERMANAND
Authorized Official Middle Name:
S. J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
225-286-4360

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  203580 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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