1558362806 NPI number — LOUISIANA COMMUNITY CARE, INC

Table of content: (NPI 1558362806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558362806 NPI number — LOUISIANA COMMUNITY CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA COMMUNITY CARE, INC
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:
Provider Other Organization Name Type Code:
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:
1558362806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 710
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71405-0710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-640-2953
Provider Business Mailing Address Fax Number:
318-641-1976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5803 MONROE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71405-3362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-640-2953
Provider Business Practice Location Address Fax Number:
318-641-1976
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLACKMAN
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-640-2953

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  522 , 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: 1713333 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1717681 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1475793 . This is a "NOW PROFESSIONAL RN #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1910023 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1162221 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1171786 . This is a "LT-PCS PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1534781 . This is a "NOW PROFESSIONAL #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1717886 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1953954 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1475556 . This is a "NOW PROFESSIONAL #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1476170 . This is a "NOW PROFESSIONAL LPN #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1717673 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1719358 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1910015 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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