# COMPANION CARE OF SWLA

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

## Provider details

- **NPI number:** 1770800724
- **Authorized official:** MR. MARK R WALLACE (COOWNER/ADMINISTRATOR)
- **Authorized official phone:** (337) 463-3550

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | PCA15351 | LA | Yes |

## Other

- **Enumeration date:** 04/30/2010
- **Last updated:** 04/30/2010