Provider Demographics
NPI:1528000965
Name:COMMCARE CORPORATION
Entity Type:Organization
Organization Name:COMMCARE CORPORATION
Other - Org Name:TRINITY TRACE COMMUNITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PSARELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-324-8950
Mailing Address - Street 1:612 HOLY TRINITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-643-5630
Mailing Address - Fax:985-649-6065
Practice Address - Street 1:612 HOLY TRINITY DRIVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-643-5630
Practice Address - Fax:985-649-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA912314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1512729Medicaid
LA31200OtherBLUE CROSS BLUE SHIELD