Healthcare Provider Details

I. General information

NPI: 1487680823
Provider Name (Legal Business Name): COMM-CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 WHITE ST
RUSTON LA
71270-7213
US

IV. Provider business mailing address

1405 WHITE ST
RUSTON LA
71270-7213
US

V. Phone/Fax

Practice location:
  • Phone: 318-225-4400
  • Fax: 318-255-1139
Mailing address:
  • Phone: 318-225-4400
  • Fax: 318-255-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number350
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1520233
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer

VIII. Authorized Official

Name: MRS. RANDY BELTON
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 601-709-1408