Organization
LAKE CHARLES SENIOR CARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY BONO (MANAGER)
(337) 532-5799
Entity
Organization
Contact information
Practice address
1909 SOUTHWOOD DR, LAKE CHARLES, LA 70605-4132
(337) 532-5799
Mailing address
1909 SOUTHWOOD DR, LAKE CHARLES, LA 70605-4132
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/09/2022
Last updated
11/09/2022
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