Healthcare Provider Details

I. General information

NPI: 1992007462
Provider Name (Legal Business Name): DEMENTIA CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 COUNTRY CLUB RD
LAKE CHARLES LA
70605-5321
US

IV. Provider business mailing address

1401 COUNTRY CLUB RD
LAKE CHARLES LA
70605-5321
US

V. Phone/Fax

Practice location:
  • Phone: 337-480-1550
  • Fax: 337-480-1341
Mailing address:
  • Phone: 337-480-1550
  • Fax: 337-480-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number747
License Number StateLA

VIII. Authorized Official

Name: MR. NEALAN J RIDER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 337-480-1550