Healthcare Provider Details

I. General information

NPI: 1053149054
Provider Name (Legal Business Name): SWLA CENTER FOR HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 CROWLEY RAYNE HWY
CROWLEY LA
70526-8209
US

IV. Provider business mailing address

526 CROWLEY RAYNE HWY
CROWLEY LA
70526-8209
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-5519
  • Fax: 337-783-5521
Mailing address:
  • Phone: 337-783-5519
  • Fax: 337-783-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY H BOUDREAUX
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 337-769-9451