Provider Demographics
NPI:1841311701
Name:COMPLETE VITAL CARE
Entity type:Organization
Organization Name:COMPLETE VITAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:VELOTTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN,MSN,CNS
Authorized Official - Phone:318-473-8800
Mailing Address - Street 1:3212 INDUSTRIAL ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3511
Mailing Address - Country:US
Mailing Address - Phone:318-473-8800
Mailing Address - Fax:318-473-8005
Practice Address - Street 1:3212 INDUSTRIAL ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3511
Practice Address - Country:US
Practice Address - Phone:318-473-8800
Practice Address - Fax:318-473-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
LA4436IR3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1267856Medicaid
LA1266141Medicaid
LA1267856Medicaid