# COMPANION CARE OF SOUTHWEST LOUISIANA

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

## Provider details

- **NPI number:** 1922505783
- **Authorized official:** MARK WALLACE (ADMINISTRATOR)
- **Authorized official phone:** (337) 463-3550

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 15351 | LA | Yes |

## Other

- **Enumeration date:** 04/09/2018
- **Last updated:** 04/09/2018