Provider Demographics
NPI:1548201437
Name:COMPASSIONATE COVENANT ADULT DAY HEALTH CARE INC.
Entity Type:Organization
Organization Name:COMPASSIONATE COVENANT ADULT DAY HEALTH CARE INC.
Other - Org Name:COMPASSIONATE CARE OF LAKE CHARLES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-474-2878
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-1441
Mailing Address - Country:US
Mailing Address - Phone:337-474-2878
Mailing Address - Fax:337-474-2875
Practice Address - Street 1:2120 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7864
Practice Address - Country:US
Practice Address - Phone:337-474-2878
Practice Address - Fax:337-474-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12843171W00000X
LA4121261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171W00000XOther Service ProvidersContractorGroup - Single Specialty
Not Answered261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1112691Medicaid
LA1170721Medicaid
LA1624063Medicaid