Organization
SOUTHWEST LOUISIANA INDEPENDENCE CENTER INC.
Active
Other names
@SLIC, @Southwest Louisiana Independence Center Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY DARTEZ (EXECUTIVE DIRECTOR)
(337) 274-8590
Entity
Organization
Contact information
Practice address
216 A LA RUE FRANCE, LAFAYETTE, LA 70508
(337) 269-0027
(337) 233-7660
Mailing address
4320 LAKE ST., LAKE CHARLES, LA 70605
(337) 477-7194
(337) 477-7194
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
12803
LA
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1305880
—
LA
Enumeration date
02/27/2007
Last updated
09/06/2023
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