Provider Demographics
NPI:1053149054
Name:SWLA CENTER FOR HEALTH SERVICES
Entity type:Organization
Organization Name:SWLA CENTER FOR HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-769-9451
Mailing Address - Street 1:526 CROWLEY RAYNE HWY
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-8209
Mailing Address - Country:US
Mailing Address - Phone:337-783-5519
Mailing Address - Fax:337-783-5521
Practice Address - Street 1:526 CROWLEY RAYNE HWY
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-8209
Practice Address - Country:US
Practice Address - Phone:337-783-5519
Practice Address - Fax:337-783-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy