Provider Demographics
NPI:1558369777
Name:INTER-COMMUNITY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:INTER-COMMUNITY HEALTH CARE, INC.
Other - Org Name:OUR LADY OF WISDOM HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:504-394-5991
Mailing Address - Street 1:5600 GENERAL DE GAULLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-7247
Mailing Address - Country:US
Mailing Address - Phone:504-394-5991
Mailing Address - Fax:504-304-5421
Practice Address - Street 1:5600 GENERAL DE GAULLE DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-7247
Practice Address - Country:US
Practice Address - Phone:504-394-5991
Practice Address - Fax:504-304-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA741314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521132Medicaid
LA195509Medicare Oscar/Certification