NPIMap

Organization Active NPI

Community Bridges South, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Ruston, LA
National Provider Identifier
1073649463
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
1035 Issued in LA
Legal business name
COMMUNITY BRIDGES SOUTH, INC.
Doing business as
Campbell Street Home
Practice address
1406 Campbell Street
Ruston, LA 71270
Phone
(318) 255-1937
Fax
(318) 255-8233
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mike L. Reynolds
Title
Ceo
Phone
(318) 255-1937

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 1035 LA Primary

Addresses

Primary practice location

1406 Campbell Street
Ruston, LA 71270

Mailing address

PO Box 715
Ruston, LA 71273-0715
Phone (318) 255-1937

Other identifiers 1

IdentifierTypeStateIssuer
1710431MedicaidLA

Other names 1

  • Campbell Street Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G253

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Campbell Street Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 19, 1988
Last certification
Apr 9, 2025
Beds
8
Ownership / control type
Private (proprietary)
Facility address
1406 Campbell Street
Ruston, LA 71270

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2020538Community Bridges South Campbell Street Home1406 Campbell Street, Ruston, LA 71270Certificate of waiverFeb 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Bridges South Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

1406 Campbell St
Ruston, LA 71270
Phone (318) 255-1937

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073649463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 715",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712730715",
            "telephone_number": "318-255-1937",
            "fax_number": "318-255-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 CAMPBELL STREET",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "71270",
            "telephone_number": "318-255-1937",
            "fax_number": "318-255-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES SOUTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-255-1937",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "1035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710431",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campbell Street Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

Sources for this page

Verify at the official NPI Registry.