Organization
SOUTHWEST LOUISIANA INDEPENDENCE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. 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 70605-4310
(337) 477-7194
(337) 477-7198
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1156
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2162187
—
LA
Enumeration date
03/16/2012
Last updated
09/06/2023
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