Healthcare Provider Details

I. General information

NPI: 1558369777
Provider Name (Legal Business Name): INTER-COMMUNITY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 GENERAL DE GAULLE DR
NEW ORLEANS LA
70131-7247
US

IV. Provider business mailing address

5600 GENERAL DE GAULLE DR
NEW ORLEANS LA
70131-7247
US

V. Phone/Fax

Practice location:
  • Phone: 504-394-5991
  • Fax: 504-304-5421
Mailing address:
  • Phone: 504-394-5991
  • Fax: 504-304-5421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number741
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN R LASTER
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 504-394-5991