# COMPANION CARE OF SWLA

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

## Provider details

- **NPI number:** 1467788976
- **Authorized official:** MR. MARK RICHARD WALLACE OWNER (CHIEF ADMINISTRATOR)
- **Authorized official phone:** (337) 396-1899

## Contact information

- **Practice address:** 1014 N PINE ST, DERIDDER, LA 70634-2818
- **Practice address phone:** (337) 463-3550
- **Practice address fax:** (337) 462-8012
- **Mailing address:** 1014A N PINE ST, DERIDDER, LA 70634-2818
- **Mailing address phone:** (337) 463-3550
- **Mailing address fax:** (337) 462-8012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | PCA15305 | LA | Yes |

## Other

- **Enumeration date:** 10/19/2009
- **Last updated:** 04/21/2010