NPIMap

Organization Active NPI

Leesville Developmental Center

Doing business as Amanda Rock Community Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Leesville, LA
National Provider Identifier
1245459213
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
273 Issued in LA
Legal business name
LEESVILLE DEVELOPMENTAL CENTER
Doing business as
Amanda Rock Community Home
Practice address
301 Knapp St
Leesville, LA 71446-3035
Phone
(337) 238-6448
NPI assigned
Apr 25, 2007
Last updated
Jun 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Authorized official

Name
Mr. Tommy Brooks
Title
Facility Services Director
Phone
(337) 239-2687

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 273 LA Primary

Addresses

Primary practice location

301 Knapp St
Leesville, LA 71446-3035

Mailing address

PO Box 131
Leesville, LA 71496-0131
Phone (337) 239-2687

Other identifiers 1

IdentifierTypeStateIssuer
1712124MedicaidLA

Other names 1

  • Amanda Rock Community Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shamrock Street Pharmacy11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1245459213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 131",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714960131",
            "telephone_number": "337-239-2687",
            "fax_number": "337-238-3723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 KNAPP ST",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714463035",
            "telephone_number": "337-238-6448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEESVILLE DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_title_or_position": "FACILITY SERVICES DIRECTOR",
        "authorized_official_telephone_number": "337-239-2687",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "LA",
            "license": "273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1712124",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amanda Rock Community Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.