Provider Demographics
NPI:1225291941
Name:COMPANION CARE OF SWLA
Entity Type:Organization
Organization Name:COMPANION CARE OF SWLA
Other - Org Name:COMPANION CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-463-3550
Mailing Address - Street 1:410 BON AMI ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4830
Mailing Address - Country:US
Mailing Address - Phone:337-463-3550
Mailing Address - Fax:337-463-8012
Practice Address - Street 1:410 BON AMI ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4830
Practice Address - Country:US
Practice Address - Phone:337-463-3550
Practice Address - Fax:337-463-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage