Active NPI
Ebony Wilridge
- Social Worker
- Lafayette, LA
National Provider Identifier
1043682016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 11260
- Practice address
- 114 Curran LN Ste a-1
Lafayette, LA 70506-7222 - Phone
- (337) 703-3037
- Fax
- (337) 340-9280
- NPI assigned
- Oct 29, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Social Worker | 104100000X | 11260 | LA | Primary |
Addresses
Primary practice location
114 Curran LN Ste a-1
Lafayette, LA 70506-7222
Mailing address
310 E Racca Rd
Jennings, LA 70546-7822
Other practice location 1
310 E Racca Rd
Jennings, LA 70546-7822
Phone (318) 652-7845
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043682016 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11260 | LA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Thriving Families LLC | Current | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FBAFAD/Endpoint/FBAFAD
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Lafayette, LA
- NPI 1659921013
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608508800000",
"number": "1043682016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 E RACCA RD",
"city": "JENNINGS",
"state": "LA",
"postal_code": "705467822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 CURRAN LN STE A-1",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705067222",
"telephone_number": "337-703-3037",
"fax_number": "337-340-9280"
}
],
"practiceLocations": [
{
"address_1": "310 E Racca Rd",
"address_purpose": "LOCATION",
"city": "Jennings",
"state": "LA",
"postal_code": "705467822",
"country_code": "US",
"telephone_number": "318-652-7845",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILRIDGE",
"first_name": "EBONY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-29",
"last_updated": "2020-12-21",
"certification_date": "2020-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "LA",
"license": "11260",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1043682016",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.