Healthcare Provider Details

I. General information

NPI: 1215396304
Provider Name (Legal Business Name): COMMUNITY CARE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S BROAD ST STE 7
NEW ORLEANS LA
70119-6447
US

IV. Provider business mailing address

200 S BROAD ST STE 7
NEW ORLEANS LA
70119-6447
US

V. Phone/Fax

Practice location:
  • Phone: 504-344-4341
  • Fax:
Mailing address:
  • Phone: 504-344-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number007603784
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateLA

VIII. Authorized Official

Name: MS. KENDRA ANNELLE CLARK
Title or Position: MHP
Credential:
Phone: 504-344-4341