NPIMap

Organization Active NPI

CLHG-Oakdale, LLC

  • Rural Health Clinic/Center
  • Oakdale, LA
National Provider Identifier
1205930450
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLHG-OAKDALE, LLC
Practice address
504 West Main
Oakdale, LA 70638-0001
Phone
(318) 634-5475
Fax
(318) 634-5161
NPI assigned
Sep 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Suzette Fatula
Title
Asst. Chief Financial Officer
Phone
(318) 215-3223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

504 West Main
Oakdale, LA 70638-0001

Mailing address

PO Box 629
Oakdale, LA 71463-0629
Phone (318) 335-3700

Other names 1

  • Elizabeth Family Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170112002739 LA Part A Provider - Rural Health Clinic 1355623943 Practice locations: Elizabeth, LA

Rural health clinic certification: CCN 193467

Legal name
CLHG-OAKDALE LLC
Doing business as
ELIZABETH FAMILY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 22, 2006
Last certification
Mar 13, 2018
Ownership / control type
1B
Most recent change of ownership
Sep 1, 2016 (1 total)
Organization structure
LLCProprietary
Incorporated
Aug 5, 2016 in LA
Enrollment address
504 W Main St
Elizabeth, LA 70638-0001
Related CCNs
190106

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Oakdale LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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
Donald Cameron Individual 5% Or Greater Direct Ownership Interest Sep 1, 2016 27%
Corporate OfficerBoard Member Sep 1, 2016
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Sep 1, 2016 65%
Corporate OfficerBoard Member Sep 1, 2016
Allegiance Health Management Inc Organization, Bossier City, LA Corporation Operational/Managerial Control Sep 1, 2016
Kevin Ardoin Individual Corporate OfficerCeo May 26, 2023
W-2 Managing Employee May 26, 2023
Operational/Managerial Control May 26, 2023
Scott Markstrom Individual 5% Or Greater Direct Ownership Interest Sep 1, 2016 8%
Corporate OfficerBoard Member Sep 1, 2016
Cameron Investments LLC Organization, Shreveport, LA LLC 5% Or Greater Direct Ownership Interest Sep 1, 2016 27%

Facilities with the same owner 53

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

View all 53

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1157760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1205930450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 629",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "714630629",
            "telephone_number": "318-335-3700",
            "fax_number": "318-215-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 WEST MAIN",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "706380001",
            "telephone_number": "318-634-5475",
            "fax_number": "318-634-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-OAKDALE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-09",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "FATULA",
        "authorized_official_first_name": "SUZETTE",
        "authorized_official_title_or_position": "ASST. CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "318-215-3223"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elizabeth Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elizabeth Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakdale, LA

Sources for this page

Verify at the official NPI Registry.