NPIMap

Organization Active NPI

Calcasieu Multi-Handicapped Center, LLC

Doing business as Calcasieu Group Home V

  • Intellectual Disabilities Intermediate Care Facility
  • Vinton, LA
National Provider Identifier
1124010236
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
755 Issued in LA
Legal business name
CALCASIEU MULTI-HANDICAPPED CENTER, LLC
Doing business as
Calcasieu Group Home V
Practice address
1223 Fancher St
Vinton, LA 70668-4319
Phone
(337) 589-9386
NPI assigned
Aug 16, 2005
Last updated
Aug 22, 2020By the provider in NPPES
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
Elizabeth Fellows
Title
Ceo
Phone
(816) 444-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 755 LA Primary

Addresses

Primary practice location

1223 Fancher St
Vinton, LA 70668-4319

Mailing address

1223 Fancher St
Vinton, LA 70668-4319
Phone (337) 589-9386

Other names 1

  • CALCASIEU GROUP HOME V Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124010236. Details of each certification follow.

  • CCN 19G479 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G479

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
Fancher Street Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 5, 1994
Last certification
Sep 16, 2025
Beds
8
Ownership / control type
Private (non-profit)
Most recent change of ownership
Oct 15, 2012
Facility address
1223 Fancher Street
Vinton, LA 70668

National Provider Directory

National Provider Directory
Tax ID family
Calcasieu Group Home I6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1223 Fancher St
Vinton, LA 70668
Phone (337) 589-9386

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124010236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1223 FANCHER ST",
            "city": "VINTON",
            "state": "LA",
            "postal_code": "706684319",
            "telephone_number": "337-589-9386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 FANCHER ST",
            "city": "VINTON",
            "state": "LA",
            "postal_code": "706684319",
            "telephone_number": "337-589-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALCASIEU MULTI-HANDICAPPED CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FELLOWS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "816-444-0900"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CALCASIEU GROUP HOME V",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vinton, LA

Sources for this page

Verify at the official NPI Registry.