NPIMap

Organization Active NPI

Southwest Louisiana Independence Center, Inc

  • In Home Supportive Care Agency
  • Lake Charles, LA
National Provider Identifier
1235265661
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
SOUTHWEST LOUISIANA INDEPENDENCE CENTER, INC
Practice address
4320 Lake St.
Lake Charles, LA 70605
Phone
(337) 477-7194
Fax
(377) 477-7198
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randy Dartez
Title
Exectuive Director
Phone
(337) 477-7194

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 11089 LA
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

4320 Lake St.
Lake Charles, LA 70605

Mailing address

4320 Lake St.
Lake Charles, LA 70605
Phone (337) 477-7194

Other identifiers 1

IdentifierTypeStateIssuer
1966738MedicaidLA

Other names 1

  • @SLIC Other name

National Provider Directory

National Provider Directory
Tax ID family
Slic15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

1202 Kirkman St
Ste C
Lake Charles, LA 70601
Phone (337) 990-5305

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1235265661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 LAKE ST.",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "70605",
            "telephone_number": "337-477-7194",
            "fax_number": "377-477-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 LAKE ST.",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "70605",
            "telephone_number": "337-477-7194",
            "fax_number": "377-477-7198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LOUISIANA INDEPENDENCE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "DARTEZ",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "EXECTUIVE DIRECTOR",
        "authorized_official_telephone_number": "337-477-7194"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "LA",
            "license": "11089",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1966738",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "@SLIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.