# SOUTHWEST LOUISIANA INDEPENDENCE CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437424991
- **Authorized official:** MR. RANDY DARTEZ (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (337) 477-7194

## Contact information

- **Practice address:** 4320 LAKE ST, LAKE CHARLES, LA 70605-4310
- **Practice address phone:** (337) 477-7194
- **Practice address fax:** (337) 477-7198
- **Mailing address:** 4320 LAKE ST, LAKE CHARLES, LA 70605-4310
- **Mailing address phone:** (337) 477-7194
- **Mailing address fax:** (337) 477-7198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | 15431 | LA | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/16/2012
- **Last updated:** 09/06/2023