Healthcare Provider Details

I. General information

NPI: 1114102738
Provider Name (Legal Business Name): COMMCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 GERSTNER MEMORIAL BLVD
LAKE CHARLES LA
70607
US

IV. Provider business mailing address

4190 GERSTNER MEMORIAL BLVD
LAKE CHARLES LA
70607-3804
US

V. Phone/Fax

Practice location:
  • Phone: 337-240-9730
  • Fax: 337-240-9731
Mailing address:
  • Phone: 337-439-5761
  • Fax: 337-433-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAWN HARVEY PSARELLIS
Title or Position: SECRETARY
Credential:
Phone: 504-324-8950