Provider Demographics
NPI:1578897682
Name:COMMUNITY CARE OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MR
Authorized Official - First Name:JC
Authorized Official - Middle Name:
Authorized Official - Last Name:CEASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-205-2833
Mailing Address - Street 1:711 DR CARVER ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5113
Mailing Address - Country:US
Mailing Address - Phone:225-205-2833
Mailing Address - Fax:
Practice Address - Street 1:308 COURT ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5248
Practice Address - Country:US
Practice Address - Phone:225-205-2833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty