Provider Demographics
NPI:1619160413
Name:ADULT CARE CENTER
Entity Type:Organization
Organization Name:ADULT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MECERLES
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-367-6630
Mailing Address - Street 1:2100 BELLE CHASSE HWY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-6651
Mailing Address - Country:US
Mailing Address - Phone:504-367-6630
Mailing Address - Fax:504-367-6601
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:B-7 STE-7
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:504-367-6630
Practice Address - Fax:504-367-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center