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General NPI Number Information
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NPI Number | 1356399299
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE CENTER OF ALEXANDRIA, LLC
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 3343 MASONIC DRIVE
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3898
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Country | US
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Telephone | 318-445-6508
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Fax | 318-445-4771
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Provider Business Mailing Address
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Address Line | 3343 MASONIC DRIVE
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3898
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Country | US
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Telephone | 318-445-6508
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Fax | 318-445-4771
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | MRS. TONI PARKINSON
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Credential |
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Telephone | 601-709-1408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 763
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License Number State | LA
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