Provider Demographics
NPI:1114102738
Name:COMMCARE CORPORATION
Entity Type:Organization
Organization Name:COMMCARE CORPORATION
Other - Org Name:CALCASIEU COMMUNITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:PSARELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-324-8950
Mailing Address - Street 1:4190 GERSTNER MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-3804
Mailing Address - Country:US
Mailing Address - Phone:337-439-5761
Mailing Address - Fax:337-433-4778
Practice Address - Street 1:4190 GERSTNER MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607
Practice Address - Country:US
Practice Address - Phone:337-240-9730
Practice Address - Fax:337-240-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1512303Medicaid
19-5644OtherMEDICARE