Healthcare Provider Details

I. General information

NPI: 1639807498
Provider Name (Legal Business Name): SWLA CENTER FOR HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N UNIVERSITY AVE
CARENCRO LA
70520-3905
US

IV. Provider business mailing address

2000 OPELOUSAS ST
LAKE CHARLES LA
70601-2641
US

V. Phone/Fax

Practice location:
  • Phone: 337-769-9451
  • Fax:
Mailing address:
  • Phone: 337-769-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BRENT III
Title or Position: CEO
Credential:
Phone: 337-769-9451