Healthcare Provider Details

I. General information

NPI: 1790742948
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

3025 FOURTH ST
JONESVILLE LA
71343-2404
US

IV. Provider business mailing address

3025 FOURTH ST
JONESVILLE LA
71343-2404
US

V. Phone/Fax

Practice location:
  • Phone: 318-339-4344
  • Fax: 318-339-4848
Mailing address:
  • Phone: 318-339-4344
  • Fax: 318-339-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number479
License Number StateMS

VIII. Authorized Official

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