Organization
COMPANION CARE OF SWLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK R WALLACE (COOWNER/ADMINISTRATOR)
(337) 463-3550
Entity
Organization
Contact information
Practice address
1014 N PINE ST, DERIDDER, LA 70634
(337) 463-3550
(337) 463-8012
Mailing address
1014 N PINE ST, SUITE A, DERIDDER, LA 70634
(337) 463-3550
(337) 463-8012
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
PCA15351
LA
Other
Enumeration date
04/30/2010
Last updated
04/30/2010
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