Healthcare Provider Details

I. General information

NPI: 1619935905
Provider Name (Legal Business Name): COMMCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 SHREVEPORT HWY
PINEVILLE LA
71360-3527
US

IV. Provider business mailing address

5201 SHREVEPORT HWY
PINEVILLE LA
71360-3527
US

V. Phone/Fax

Practice location:
  • Phone: 318-640-3014
  • Fax: 318-640-4927
Mailing address:
  • Phone: 318-640-3014
  • Fax: 318-640-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number332
License Number StateLA

VIII. Authorized Official

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