Provider Demographics
NPI:1891202776
Name:ALLCARE OF LOUISIANA, INC.
Entity Type:Organization
Organization Name:ALLCARE OF LOUISIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANARA
Authorized Official - Middle Name:
Authorized Official - Last Name:POUNCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-670-7461
Mailing Address - Street 1:4615 MONKHOUSE DR STE 116
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-6123
Mailing Address - Country:US
Mailing Address - Phone:318-670-7461
Mailing Address - Fax:
Practice Address - Street 1:4615 MONKHOUSE DR STE 116
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-6123
Practice Address - Country:US
Practice Address - Phone:318-670-7461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LABH0012322OtherBHS LICENSE #