Admin Client || Dee Karawadra

Created On Jul, 23 2025 16:37pm ID #8118 Back

Merchant (Business) DBA Name : Omni Psychiatric & Wellness Group

Business Legal Name : Omni Psychiatric & Wellness Group LLC

Contact Name : Christie Dronette

Contact Phone Number : 337-504-2332

Physical Address : 100 Asma Blvd Suite 200E

City : Lafayette

State :

Country :

Zip : 70508

Email Address : [email protected]

<?xml version="1.0"?>
<object>
  <sales_number>12232233</sales_number>
  <sales_office/>
  <sales_signing_rep/>
  <irs_tax_id_type>Employer Identification Number</irs_tax_id_type>
  <irs_tax_id_no>331560692</irs_tax_id_no>
  <ownership_type>LLC</ownership_type>
  <business_incorporated>Louisiana (LA)</business_incorporated>
  <business_description/>
  <mailing_address>100 Asma Blvd Suite 200E</mailing_address>
  <mailing_city>Lafayette</mailing_city>
  <mailing_state/>
  <mailing_zip>70508</mailing_zip>
  <business_phone>337-504-2332</business_phone>
  <contact_first_name>Christie</contact_first_name>
  <contact_last_name>Dronette</contact_last_name>
  <contact_phone>337-504-2332</contact_phone>
  <location_address>100 Asma Blvd Suite 200E</location_address>
  <location_city>Lafayette</location_city>
  <location_state/>
  <location_zip>70508</location_zip>
  <avg_ticket_amount>150</avg_ticket_amount>
  <ave_month_volume>15000</ave_month_volume>
  <bank_name>Home Bank</bank_name>
  <bank_transit_number>265270303</bank_transit_number>
  <bank_dda_no>4052353017</bank_dda_no>
  <gross_vs_net>Net Settlement</gross_vs_net>
  <refund_policy/>
  <owner1_first_name>Bryant</owner1_first_name>
  <owner1_last_name>Dronette</owner1_last_name>
  <owner1_home_address>142 Hundred Oaks Dr</owner1_home_address>
  <owner1_home_city>Youngsville</owner1_home_city>
  <owner1_home_state>LA</owner1_home_state>
  <owner1_home_zip>70592</owner1_home_zip>
  <owner1_home_phone>337-501-9618</owner1_home_phone>
  <owner1_title>Owner</owner1_title>
  <owner1_ownership_perc>50</owner1_ownership_perc>
  <owner1_dob>1967-10-17</owner1_dob>
  <owner1_social_securrity_no>435-11-1919</owner1_social_securrity_no>
  <owner1_form_of_id>Drivers License</owner1_form_of_id>
  <owner1_number>002716650</owner1_number>
  <owner1_expired>2029-10-17</owner1_expired>
  <owner1_issuer_state>LA</owner1_issuer_state>
  <owner1_issued_date>2021-09-29</owner1_issued_date>
  <beneficiary2_first_name>Christie</beneficiary2_first_name>
  <beneficiary2_last_name>Dronette</beneficiary2_last_name>
  <beneficiary2_home_address>142 Hundred Oaks Dr</beneficiary2_home_address>
  <beneficiary2_home_city>Youngsville</beneficiary2_home_city>
  <beneficiary2_home_state>LA</beneficiary2_home_state>
  <beneficiary2_home_zip>70592</beneficiary2_home_zip>
  <beneficiary2_home_phone>337-501-9618</beneficiary2_home_phone>
  <beneficiary2_title>Owner</beneficiary2_title>
  <beneficiary2_ownership_perc>50</beneficiary2_ownership_perc>
  <beneficiary2_dob>1969-11-18</beneficiary2_dob>
  <beneficiary2_social_securrity_no>433-35-5247</beneficiary2_social_securrity_no>
  <beneficiary2_form_of_id>Drivers License</beneficiary2_form_of_id>
  <beneficiary2_number>005204761</beneficiary2_number>
  <beneficiary2_expired>2029-11-18</beneficiary2_expired>
  <beneficiary2_issuer_state>LA</beneficiary2_issuer_state>
  <beneficiary2_issued_date>2024-05-30</beneficiary2_issued_date>
</object>

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