Provider Demographics
NPI:1558362806
Name:LOUISIANA COMMUNITY CARE, INC
Entity Type:Organization
Organization Name:LOUISIANA COMMUNITY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-640-2953
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-0710
Mailing Address - Country:US
Mailing Address - Phone:318-640-2953
Mailing Address - Fax:318-641-1976
Practice Address - Street 1:5803 MONROE HWY
Practice Address - Street 2:
Practice Address - City:BALL
Practice Address - State:LA
Practice Address - Zip Code:71405-3362
Practice Address - Country:US
Practice Address - Phone:318-640-2953
Practice Address - Fax:318-641-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA522315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1713333Medicaid
LA1717681Medicaid
LA1475793OtherNOW PROFESSIONAL RN #
LA1910023Medicaid
LA1162221Medicaid
LA1171786OtherLT-PCS PROVIDER NUMBER
LA1534781OtherNOW PROFESSIONAL #
LA1717886Medicaid
LA1953954Medicaid
LA1475556OtherNOW PROFESSIONAL #
LA1476170OtherNOW PROFESSIONAL LPN #
LA1717673Medicaid
LA1719358Medicaid
LA1910015Medicaid