Healthcare Provider Details

I. General information

NPI: 1528000965
Provider Name (Legal Business Name): COMMCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 HOLY TRINITY DRIVE
COVINGTON LA
70433
US

IV. Provider business mailing address

612 HOLY TRINITY DRIVE
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-5630
  • Fax: 985-649-6065
Mailing address:
  • Phone: 985-643-5630
  • Fax: 985-649-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number912
License Number StateLA

VIII. Authorized Official

Name: DAWN H PSARELLIS
Title or Position: VP, CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 504-324-8950