NPIMap

Organization Active NPI

Community Bridges South, Inc.

Doing business as Calvin Road Community Residence

  • Intellectual Disabilities Intermediate Care Facility
  • Winnfield, LA
National Provider Identifier
1194851584
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
587 Issued in LA
Legal business name
COMMUNITY BRIDGES SOUTH, INC.
Doing business as
Calvin Road Community Residence
Practice address
618 Joe Frazier Rd
Winnfield, LA 71483-5029
Phone
(318) 255-9137
Fax
(318) 255-8233
NPI assigned
Feb 27, 2007
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
Mr. Mike L. Reynolds
Title
Ceo
Phone
(318) 255-9137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 587 LA Primary

Addresses

Primary practice location

618 Joe Frazier Rd
Winnfield, LA 71483-5029

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1718475MedicaidLA

Other names 1

  • Calvin Road Community Residence 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 1194851584. Details of each certification follow.

  • CCN 19G328 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G328

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
Calvin Road Community Residence
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 31, 1989
Last certification
Mar 11, 2026
Beds
8
Ownership / control type
Private (proprietary)
Facility address
618 Joe Fraizer Road
Winnfield, LA 71483

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
19D1096640Calvin Community Residence618 Joe Frazier Road, Winnfield, LA 71483Certificate of waiverMar 9, 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

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": "1194851584",
    "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",
            "fax_number": "318-255-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 JOE FRAZIER RD",
            "city": "WINNFIELD",
            "state": "LA",
            "postal_code": "714835029",
            "telephone_number": "318-255-9137",
            "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": "318-255-9137",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1718475",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Calvin Road Community Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winnfield, LA

Sources for this page

Verify at the official NPI Registry.