| Organization Name: | COMPANION CARE OF SWLA |
| NPI Number: | 1467788976 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK RICHARD WALLACE (CHIEF ADMINISTRATOR) |
| Mailing Address: | 1014 N Pine St Deridder |
| State: | LA US |
| Postal Code: | 706342818 |
| Phone Number: | 3374633550 |
| Fax Number: | 3374628012 |
| NPI Enumeration Date: | 10/19/2009 |
| NPI Last Update Date: | 04/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | PCA15305 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |