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Organization

SOUTHWEST LOUISIANA INDEPENDENCE CENTER INC

Active
Other names
@SLIC
Organization subpart
No

Provider details

NPI number
Authorized official
RANDY DARTEZ (EXECUTIVE DIRECTOR)
(337) 477-7194
Entity
Organization

Contact information

Practice address
4320 LAKE ST, LAKE CHARLES, LA 70605-4310
(337) 477-7194
(337) 477-7198
Mailing address
4320 LAKE ST., LAKE CHARLES, LA 70605
(337) 477-7194
(337) 477-7198

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
11256
LA
253Z00000X
In Home Supportive Care Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1023183
LA
Enumeration date
09/17/2007
Last updated
09/06/2023
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