Healthcare Provider Details

I. General information

NPI: 1376725952
Provider Name (Legal Business Name): SWLA CENTER FOR HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PATTERSON ST
LAFAYETTE LA
70501-1849
US

IV. Provider business mailing address

2000 OPELOUSAS STREET
LAKE CHARLES LA
70601
US

V. Phone/Fax

Practice location:
  • Phone: 337-769-9451
  • Fax: 337-769-9460
Mailing address:
  • Phone: 337-439-9983
  • Fax: 337-497-2556

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: JAMYA A MOUTON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 337-769-9451