1962934505 NPI number — COMMCARE CORPORATION

Table of content: (NPI 1962934505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962934505 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:
Provider Other Organization Name Type Code:
6
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:
1962934505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 GENERAL DE GAULLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70131-7247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-394-5991
Provider Business Mailing Address Fax Number:
504-227-3626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 GENERAL DEGAULLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70131-7247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-394-5991
Provider Business Practice Location Address Fax Number:
504-304-5421
Provider Enumeration Date:
04/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PSARELLIS
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
HARVEY
Authorized Official Title or Position:
VP, CAO
Authorized Official Telephone Number:
504-324-8950

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1521132 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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