1518905983 NPI number — COMMCARE CORPORATION

Table of content: (NPI 1518905983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518905983 NPI number — COMMCARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMCARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OLD BROWNLEE COMMUNITY CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518905983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4680 OLD BROWNLEE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSSIER CITY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-553-5950
Provider Business Mailing Address Fax Number:
318-553-5952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4680 OLD BROWNLEE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-326-4259
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PSARELLIS
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
VP, CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
504-324-8950

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  249 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518506 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com