NPIMap

Organization Active NPI

Southwest Louisiana Independence Center, Inc

  • In Home Supportive Care Agency
  • Lake Charles, LA
National Provider Identifier
1437424991
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 70605-4310
Phone
(337) 477-7194
Fax
(337) 477-7198
NPI assigned
Mar 16, 2012
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
Mr. Randy Dartez
Title
Executive Director
Phone
(337) 477-7194

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 15431 LA
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

4320 Lake St
Lake Charles, LA 70605-4310

Mailing address

4320 Lake St
Lake Charles, LA 70605-4310
Phone (337) 477-7194

Other identifiers 1

IdentifierTypeStateIssuer
2164686MedicaidLA

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

2016 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 429-5248

NPI Registry JSON

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1437424991",
    "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": "706054310",
            "telephone_number": "337-477-7194",
            "fax_number": "337-477-7198"
        },
        {
            "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": "706054310",
            "telephone_number": "337-477-7194",
            "fax_number": "337-477-7198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LOUISIANA INDEPENDENCE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "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": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "337-477-7194",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "LA",
            "license": "15431",
            "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": "2164686",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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.