Healthcare Provider Details

I. General information

NPI: 1639136989
Provider Name (Legal Business Name): COMMCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 THOMAS RD
BATON ROUGE LA
70811-7354
US

IV. Provider business mailing address

5550 THOMAS RD
BATON ROUGE LA
70811-7354
US

V. Phone/Fax

Practice location:
  • Phone: 225-774-2141
  • Fax: 225-774-2143
Mailing address:
  • Phone: 225-774-2141
  • Fax: 225-774-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number849
License Number StateLA

VIII. Authorized Official

Name: MS. DAWN H PSARELLIS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 504-324-8950