Provider Demographics
NPI:1558431106
Name:SOUTHWEST LOUISIANA AIDS COUNCIL
Entity Type:Organization
Organization Name:SOUTHWEST LOUISIANA AIDS COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-439-5861
Mailing Address - Street 1:1715 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6135
Mailing Address - Country:US
Mailing Address - Phone:337-439-5861
Mailing Address - Fax:337-436-8713
Practice Address - Street 1:1715 COMMON ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6135
Practice Address - Country:US
Practice Address - Phone:337-439-5861
Practice Address - Fax:337-436-8713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM 4387251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1160792-HIVMedicaid