NPIMap

Organization Active NPI

Roosevelt Community Home

  • Intellectual Disabilities Intermediate Care Facility
  • Alexandria, LA
National Provider Identifier
1174766364
Registry record updated Nov 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
1054 Issued in LA
Legal business name
ROOSEVELT COMMUNITY HOME
Practice address
1605 Texas Ave
Alexandria, LA 71301-4050
Phone
(318) 443-9330
Fax
(318) 443-9359
NPI assigned
Apr 17, 2009
Last updated
Nov 7, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
WESTSIDE HABILITATION CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2009

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

Authorized official

Name
Christina Bonnette Bolton
Title
Administrator
Phone
(318) 445-1551

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 1054 LA Primary

Addresses

Primary practice location

1605 Texas Ave
Alexandria, LA 71301-4050

Mailing address

PO Box 7917
Alexandria, LA 71306-0917
Phone (318) 445-1551

Other identifiers 1

IdentifierTypeStateIssuer
19G654MedicaidLA

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 1174766364. Details of each certification follow.

  • CCN 19G654 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G654

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
Roosevelt Community Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 13, 2009
Last certification
Jul 10, 2025
Ownership / control type
Private (non-profit)
Facility address
1605 Texas Avenue
Alexandria, LA 71301

National Provider Directory

National Provider Directory
Tax ID family
Taft Community Home28 organizations share this tax ID, including this one
Part of
Taft Community Home

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257552000000",
    "number": "1174766364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7917",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713060917",
            "telephone_number": "318-445-1551",
            "fax_number": "318-445-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 TEXAS AVE",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713014050",
            "telephone_number": "318-443-9330",
            "fax_number": "318-443-9359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSEVELT COMMUNITY HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTSIDE HABILITATION CENTER",
        "enumeration_date": "2009-04-17",
        "last_updated": "2009-11-07",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "BONNETTE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-445-1551"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "1054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19G654",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, LA

Sources for this page

Verify at the official NPI Registry.