Organization
COMPANION CARE OF SWLA
Active
Other names
Companion Care of Southwest Louisiana
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WALLACE (OWNER)
(337) 463-3550
Entity
Organization
Contact information
Practice address
1014A N PINE ST, DERIDDER, LA 70634-2818
(337) 463-3550
(337) 463-8012
Mailing address
1014A N PINE ST, DERIDDER, LA 70634-2818
(337) 463-3550
(337) 463-8012
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
PCA 15351
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PCA 15351
DEPARTMENT OF HEALTH & HOSPITALS
LA
Enumeration date
04/28/2010
Last updated
04/28/2010
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