Organization
COMMCARE CORPORATION
Active
Other names
Trinity Trace Community Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN H PSARELLIS (VP, CHIEF ADMINISTRATIVE OFFICER)
(504) 324-8950
Entity
Organization
Contact information
Practice address
612 HOLY TRINITY DRIVE, COVINGTON, LA 70433
(985) 643-5630
(985) 649-6065
Mailing address
612 HOLY TRINITY DRIVE, COVINGTON, LA 70433
(985) 643-5630
(985) 649-6065
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
912
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512729
—
LA
01
—
31200
BLUE CROSS BLUE SHIELD
LA
Enumeration date
06/11/2006
Last updated
02/18/2021
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