Provider Demographics
NPI:1356399299
Name:COMMUNITY CARE CENTER OF ALEXANDRIA, LLC
Entity type:Organization
Organization Name:COMMUNITY CARE CENTER OF ALEXANDRIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:3343 MASONIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3898
Mailing Address - Country:US
Mailing Address - Phone:318-445-6508
Mailing Address - Fax:318-445-4771
Practice Address - Street 1:3343 MASONIC DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3898
Practice Address - Country:US
Practice Address - Phone:318-445-6508
Practice Address - Fax:318-445-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA763314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521329Medicaid
LA30982OtherBLUE CROSS BLUE SHIELD
LA195479Medicare Oscar/Certification