Provider Demographics
NPI:1245231992
Name:COMMCARE CORPORATION
Entity Type:Organization
Organization Name:COMMCARE CORPORATION
Other - Org Name:WYNHOVEN COMMUNITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CAO
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 1:950 W CAUSEWAY APPROACH
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3082
Mailing Address - Country:US
Mailing Address - Phone:504-324-8950
Mailing Address - Fax:985-624-3477
Practice Address - Street 1:1050 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3144
Practice Address - Country:US
Practice Address - Phone:504-347-0777
Practice Address - Fax:504-341-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
LA454314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1517313Medicaid
LA195210Medicare PIN
LA0366150001Medicare NSC