Provider Demographics
NPI:1588622286
Name:COMMCARE CORPORATION
Entity Type:Organization
Organization Name:COMMCARE CORPORATION
Other - Org Name:HERITAGE MANOR NATCHITOCHES REHAB & RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MS
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 1:720 KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6043
Mailing Address - Country:US
Mailing Address - Phone:318-352-8296
Mailing Address - Fax:318-352-3837
Practice Address - Street 1:720 KEYSER AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6043
Practice Address - Country:US
Practice Address - Phone:318-352-8296
Practice Address - Fax:318-352-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA887314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510921Medicaid
LA31059OtherBLUE CROSS BLUE SHIELD
LA195405Medicare Oscar/Certification