NPIMap

Organization Active NPI

Community Bridges South, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Bossier City, LA
National Provider Identifier
1114600749
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
COMMUNITY BRIDGES SOUTH, INC.
Doing business as
Jericho Community Home
Practice address
2515 Brownlee Rd
Bossier City, LA 71111-2011
Phone
(318) 255-9137
NPI assigned
Aug 10, 2023
Organization subpart
Yes
Parent organization
COMMUNITY BRIDGES SOUTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Authorized official

Name
Matthew R Price, ATC
Title
Ceo
Phone
(205) 712-1381

Specialties & licenses 1

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

Addresses

Primary practice location

2515 Brownlee Rd
Bossier City, LA 71111-2011

Mailing address

PO Box 715
Ruston, LA 71273-0715
Phone (318) 255-9137

Other names 1

  • Jericho Community Home Doing business as

National Provider Directory

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

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1114600749",
    "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": "318-255-9137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 BROWNLEE RD",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112011",
            "telephone_number": "318-255-9137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES SOUTH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY BRIDGES SOUTH, INC.",
        "enumeration_date": "2023-08-10",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-712-1381",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jericho Community Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.