NPIMap

Organization Active NPI

LTAC of Louisiana, LLC

Doing business as LTAC of Louisiana

  • Long Term Care Hospital
  • Lafayette, LA
National Provider Identifier
1205075181
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
LTAC OF LOUISIANA, LLC
Doing business as
LTAC of Louisiana
Lafayette-AMG Specialty Hospital
Practice address
4811 Ambassador Caffery Pkwy FL 4
Lafayette, LA 70508-7265
Phone
(337) 456-8201
Fax
(337) 456-8202
NPI assigned
Feb 17, 2009
Last updated
Aug 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Authorized official

Name
Ms. Jessica L McGee, MBA
Title
Cfo
Phone
(337) 269-9828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X NU Primary

Addresses

Primary practice location

4811 Ambassador Caffery Pkwy FL 4
Lafayette, LA 70508-7265

Mailing address

101 La Rue France Ste 100
Lafayette, LA 70508-3138
Phone (337) 269-9566

Other names 2

  • LTAC of Louisiana Doing business as
  • Lafayette-AMG Specialty Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090323000124 LA Part A Provider - Hospital 2466519236 Practice locations: Lafayette, LA
O20110105000709 LA Part B Supplier - Clinic/Group Practice 2466519236 Receives reassigned benefits from 1 practitioner
Practice locations: Lafayette, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205075181. Details of each certification follow.

Hospital certification: CCN 192029

Legal name
LTAC OF LOUISIANA, LLC
Doing business as
LAFAYETTE-AMG SPECIALTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jan 1, 2001
Last certification
Jul 15, 2025
Beds
46
Ownership / control type
Private (for profit)
Most recent change of ownership
Feb 15, 2009 (2 total)
Organization structure
LLCProprietary
Incorporated
Mar 1, 2009 in LA
Enrollment address
4811 Ambassador Caffery Pkwy
FL 4
Lafayette, LA 70508-7265
Other Hospital Practice Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Lafayette - a M G Specialty HospitalCCN 192029 · All quality measures
Ownership
For profit
Certified
Jan 1, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Beds
46

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
19D2081564Lafayette-Amg Specialty Hospital Park Place Compus4811 Ambassador Caffery Parkway, 4TH Floor, Lafayette, LA 70508Certificate of waiverJul 27, 2028

National Provider Directory

National Provider Directory

Locations

101 La Rue France
Ste 300
Lafayette, LA 70508
Phone (337) 269-5929

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Amg 2 0 Holdco Inc Organization, Lafayette, LA Corporation 5% Or Greater Indirect Ownership Interest Dec 27, 2019 100%
Amg 2 0 LLC Organization, Lafayette, LA 5% Or Greater Direct Ownership Interest Nov 1, 2019
Timothy W Howard Individual Corporate OfficerPresident Dec 27, 2019 100%
Corporate Director Dec 27, 2019 100%
Jessica L McGee Individual Corporate Director Feb 15, 2009
April Ebeling Individual W-2 Managing EmployeeHospital Administrator Jun 1, 2020 50%
August J Rantz Individual Corporate Officer Dec 27, 2019 100%
Corporate Director Feb 15, 2009 100%

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1205075181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LA RUE FRANCE STE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083138",
            "telephone_number": "337-269-9566",
            "fax_number": "337-269-9823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 AMBASSADOR CAFFERY PKWY FL 4",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705087265",
            "telephone_number": "337-456-8201",
            "fax_number": "337-456-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTAC OF LOUISIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-17",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "MCGEE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-269-9828",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LTAC of Louisiana",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lafayette-AMG Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.