Provider Demographics
NPI:1942645007
Name:SWLA CENTER FOR HEALTH SERVICES
Entity Type:Organization
Organization Name:SWLA CENTER FOR HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KOBRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-493-5112
Mailing Address - Street 1:2000 OPELOUSAS STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-439-9983
Mailing Address - Fax:337-439-3224
Practice Address - Street 1:112 N. SIXTH STREET
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:LA
Practice Address - Zip Code:70655
Practice Address - Country:US
Practice Address - Phone:337-639-2281
Practice Address - Fax:337-639-6199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWLA CENTER FOR HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-02
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2351150Medicaid