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Organization
COMPANION CARE OF SWLA
Active
Organization
COMPANION CARE OF SWLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK RICHARD WALLACE OWNER (CHIEF ADMINISTRATOR)
(337) 396-1899
Entity
Organization
Contact information
Practice address
1014 N PINE ST, DERIDDER, LA 70634-2818
(337) 463-3550
(337) 462-8012
Mailing address
1014A N PINE ST, DERIDDER, LA 70634-2818
(337) 463-3550
(337) 462-8012
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
PCA15305
LA
Other
Enumeration date
10/19/2009
Last updated
04/21/2010
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