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NPI Code Detail

MEDICARE: LOUISIANA COMMUNITY CARE INC

MEDICARE: LOUISIANA COMMUNITY CARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1315P00000XIntellectual Disabilities Intermediate Care Facility2673LA

General Provider Information

NPI Number : 1417128257
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOUISIANA COMMUNITY CARE INC
Provider Business Mailing Address
First Line : PO BOX 710
Second Line :
City : BALL
State : LA
Zip : 71405-0710
Country : US
Telephone Number : 318-640-2953
Fax Number : 318-641-1976
Provider Business Practice Location Address
First Line : 5803 MONROE HWY
Second Line :
City : BALL
State : LA
Zip : 71405-3362
Country : US
Telephone Number : 318-640-2953
Fax Number : 318-641-1976
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. ALBERT E BLACKMAN
Credential :
Telephone Number : 318-640-2953
Provider Enumeration Date : 03/20/2008
Last Update Date : 03/20/2008

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Directions to “LOUISIANA COMMUNITY CARE INC ” Practice Location

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