NPIMap

Organization Active NPI

Council for Advancement of Social Service and Education

  • Federally Qualified Health Center (FQHC)
  • Stonewall, LA
National Provider Identifier
1104340686
Registry record updated Nov 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Practice address
149 Stonecreek Dr.
Stonewall, LA 71078-4906
Phone
(318) 688-3350
Fax
(318) 688-3655
NPI assigned
Jul 27, 2017
Organization subpart
Yes
Parent organization
COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2017

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

Authorized official

Name
Mr. Jeff Moody
Title
C.O.O.
Phone
(318) 688-3350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

149 Stonecreek Dr.
Stonewall, LA 71078-4906

Mailing address

2120 Bert Kouns Industrial Loop Ste a
Shreveport, LA 71118-3351
Phone (318) 688-3350

Other names 1

  • CASSE Community Health - Stonewall Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170906002610 LA Part A Provider - Federally Qualified Health Center (FQHC) 8022043710 Practice locations: Stonewall, LA

Federally qualified health center certification: CCN 191977

Legal name
COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Doing business as
CASSE COMMUNITY HEALTH - STONEWALL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 6, 2017
Last certification
Sep 6, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 1996 in LA
Enrollment address
149 Stonecreek Dr
Stonewall, LA 71078-4906

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Council for the Advancement of Social Services and Education10 organizations share this tax ID, including this one
Part of
Council for the Advancement of Social Services and Education

Other organizations with this tax ID 9

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

Locations

1560 Irving Pl
Shreveport, LA 71101
Phone (318) 212-1194

2120 Bert Kouns Industrial Loop
Ste K
Shreveport, LA 71118

149 Stone Creek Rd
Stonewall, LA 71078
Phone (318) 688-3350

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mary M Chumley Individual Corporate OfficerPres/Ceo Dec 23, 1996 100%
Operational/Managerial ControlPres/Ceo Dec 23, 1996 100%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Casse Community Health InstituteMansfield, LA, CCN 191883 Federally qualified health center Operational/Managerial Control Feb 13, 2006

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511740800000",
    "number": "1104340686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 BERT KOUNS INDUSTRIAL LOOP STE A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183351",
            "telephone_number": "318-688-3350",
            "fax_number": "318-688-3655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 STONECREEK DR.",
            "city": "STONEWALL",
            "state": "LA",
            "postal_code": "710784906",
            "telephone_number": "318-688-3350",
            "fax_number": "318-688-3655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION",
        "enumeration_date": "2017-07-27",
        "last_updated": "2017-11-27",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "318-688-3350",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CASSE Community Health - Stonewall",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stonewall, LA

Sources for this page

Verify at the official NPI Registry.