Healthcare Provider Details

I. General information

NPI: 1508083114
Provider Name (Legal Business Name): COMM CARE CORP DBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 LEE STREET
ALEXANDRIA LA
71360
US

IV. Provider business mailing address

140 FLAGON LOOP
PINEVILLE LA
71360-3761
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-6163
  • Fax: 318-442-4779
Mailing address:
  • Phone: 318-442-3163
  • Fax: 318-442-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberRN080924
License Number StateLA

VIII. Authorized Official

Name: MRS. BRENDA KAY WELCH
Title or Position: PROGRAM NURSE
Credential: R.N.
Phone: 318-442-3163