Provider Demographics
NPI:1942749809
Name:I CARE MENTAL HEALTH FACILITY
Entity Type:Organization
Organization Name:I CARE MENTAL HEALTH FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAJOURNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-680-3046
Mailing Address - Street 1:817 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ST. MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582
Mailing Address - Country:US
Mailing Address - Phone:337-680-3046
Mailing Address - Fax:
Practice Address - Street 1:817 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-4411
Practice Address - Country:US
Practice Address - Phone:337-680-3046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)