WOODLAKE MANAGEMENT, LLC (NPI# 1053648774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053648774 |
| Entity Type | Organization |
| Organization Name | WOODLAKE MANAGEMENT, LLC |
| Other Organization Name | WOODLAKE ADDICTION RECOVERY CENTER |
| Practice Address |
3015 Highway 956 Ethel LA 70730-4520 |
| Practice Telephone | 2256814144 |
| Practice Fax Number | 2256824142 |
| Mailing Telephone | 2256814144 |
| Mailing Fax Number | 2256824142 |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2009-11-17 |
| Authorized Official Name | RANDAL ANTHONY GOMEZ (MANAGING MEMBER) |
| Authorized Official Telephone | 2256834144 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 156 | LA | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Woodlake Addiction Recovery Center | Doing Business As Name - Organization |
| Street Address |
3015 HIGHWAY 956 |
| City | ETHEL |
| State | LA |
| Zip Code | 70730-4520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303432 | Craig Encalade | Counselor | 3015 Highway 956, Ethel, LA 70730-4520 | 2020-10-16 |
| 1346860319 | Rhonda Michelle Newman | Counselor | 3015 Highway 956, Ethel, LA 70730-4520 | 2020-04-20 |
| 1679107809 | Lauren Bennett Hutchinson | Counselor | 3015 Highway 956, Ethel, LA 70730-4520 | 2020-02-26 |
| 1043776123 | Kayla Marie Davis | Counselor | 3015 Highway 956, Ethel, LA 70730-4520 | 2019-02-14 |
| 1285199117 | Emily Toloudis | Counselor | 3015 Highway 956, Ethel, LA 70730-4520 | 2019-02-05 |
| 1700341880 | Jeff Cullen Monroe | Counselor | 3015 Highway 956, Ethel, LA 70730-4520 | 2019-02-04 |
| 1679038616 | Ilisha Lucas | Counselor | 3015 Highway 956, Ethel, LA 70730-4520 | 2019-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871736264 | Juanta T Buggage | Speech-Language Pathologist | 5941 Dennis Mack Ln, Ethel, LA 70730-4031 | 2009-04-14 |
| 1811557127 | Amanda Engels | Chiropractor | 4014 Lillian Ln, Ethel, LA 70730-4416 | 2019-06-18 |
| 1215253091 | Katherine Eagle Ledoux | Nurse Practitioner | 2876 Highway 956, Ethel, LA 70730-4518 | 2010-04-19 |
| 1497173637 | Ledoux Healthcare Services LLC | Nurse Practitioner | 2876 Highway 956, Ethel, LA 70730-4518 | 2014-04-04 |
| 1205173713 | Valerie L Ghoram | Social Worker | 3618 Highway 956, Ethel, LA 70730-4526 | 2013-01-04 |
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
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| 1073122420 | Second Chances Recovery Center LLC | Substance Abuse Rehabilitation Facility | 161 Coumeaux Road, Rayville, LA 71269 | 2020-07-30 |
| 1215550736 | Cataldie Publishing LLC | Substance Abuse Rehabilitation Facility | 349 Highway 61, Jackson, LA 70748-4218 | 2020-05-19 |
| 1952935983 | Broken Wings Recovery Center, LLC | Substance Abuse Rehabilitation Facility | 2869 New Monroe Road, Bastrop, LA 71220 | 2020-02-28 |
| 1881233419 | Addiction Solutions LLC | Substance Abuse Rehabilitation Facility | 216 Ouachita Ave Ste B, Monroe, LA 71201-8513 | 2019-12-30 |
| 1801430962 | Baton Rouge Recovery Health LLC | Substance Abuse Rehabilitation Facility | 3600 Florida Blvd Ste 4t, Baton Rouge, LA 70806-3842 | 2019-11-01 |
| 1134788797 | Odyssey House Louisiana, Inc | Substance Abuse Rehabilitation Facility | 2700 S. Broad St, New Orleans, LA 70125 | 2019-06-07 |
| 1518424258 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 4330 Loveland St Ste A, Metairie, LA 70006-4179 | 2019-03-01 |
| 1346707080 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 7434 Picardy Ave Ste A&b, Baton Rouge, LA 70808-7204 | 2019-03-01 |
| 1528525268 | Lake Wellness Center, LLC | Substance Abuse Rehabilitation Facility | 4540 Ambassador Caffery Pkwy Ste C110, Lafayette, LA 70508-6937 | 2019-03-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.