NPIMap

Organization Active NPI

Medical Management Enterprises

  • Intellectual Disabilities Intermediate Care Facility
  • Gonzales, LA
National Provider Identifier
1275739997
Registry record updated Sep 3, 2013
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Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
483 Issued in LA
Legal business name
MEDICAL MANAGEMENT ENTERPRISES
Practice address
1238 N Barman Ave
Gonzales, LA 70737-2440
Phone
(225) 644-7994
NPI assigned
Jun 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2013

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

Authorized official

Name
Gary W. Borg
Title
President
Phone
(225) 644-7994

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 483 LA Primary

Addresses

Primary practice location

1238 N Barman Ave
Gonzales, LA 70737-2440

Mailing address

PO Box 819
Gonzales, LA 70707-0819
Phone (225) 644-7994

Other identifiers 1

IdentifierTypeStateIssuer
1717223MedicaidLA

Other names 1

  • Pennville Community Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G224

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
Pennville Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 20, 1987
Last certification
Jun 4, 2025
Beds
8
Ownership / control type
Private (proprietary)
Facility address
1238 North Barman Avenue
Gonzales, LA 70737

National Provider Directory

National Provider Directory
Tax ID family
Medical Management Enterprises4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378166400000",
    "number": "1275739997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 819",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707070819",
            "telephone_number": "225-644-7994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1238 N BARMAN AVE",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707372440",
            "telephone_number": "225-644-7994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MANAGEMENT ENTERPRISES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2013-09-03",
        "status": "A",
        "authorized_official_last_name": "BORG",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "225-644-7994"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1717223",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pennville Community Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gonzales, LA

Sources for this page

Verify at the official NPI Registry.