NPIMap

Organization Active NPI

Life Source Services, LLC

Doing business as Life Source Services Baton Rouge

  • Community Based Hospice Care Agency
  • Baton Rouge, LA
National Provider Identifier
1356309199
Registry record updated Aug 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
148 Issued in LA
Legal business name
LIFE SOURCE SERVICES, LLC
Doing business as
Life Source Services Baton Rouge
Practice address
3049 S Sherwood Forest Blvd
Suite 100
Baton Rouge, LA 70816-2277
Phone
(225) 291-9421
Fax
(225) 291-9743
NPI assigned
May 2, 2006
Last updated
Aug 7, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2007

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

Authorized official

Name
Mrs. Randy Belton
Title
Authorized Representative
Phone
(601) 709-1408

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 148 LA Primary

Addresses

Primary practice location

3049 S Sherwood Forest Blvd
Suite 100
Baton Rouge, LA 70816-2277

Mailing address

3049 S Sherwood Forest Blvd
Suite 100
Baton Rouge, LA 70816-2277
Phone (225) 291-9421

Other names 1

  • Life Source Services Baton Rouge Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040713000243 LA Part A Provider - Hospice 7517945819 Practice locations: Baton Rouge, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356309199. Details of each certification follow.

Hospice certification: CCN 191591

Legal name
LIFE SOURCE SERVICES LLC
Doing business as
LIFE SOURCE SERVICES OF BATON ROUGE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 27, 2004
Last certification
Aug 4, 2021
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
in LA
Enrollment address
11605 Southfork Ave Ste a
Baton Rouge, LA 70816-5220

Care Compare: Hospice

Medicare Care Compare
Listed as
Life Source Services of Baton RougeCCN 191591 · All quality measures
Ownership
Other
Certified
Sep 27, 2004
Medicare certification status
ActiveFrom the Provider of Services file

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
19D1029664Life Source Services LLC11605 Southfork Ave, Ste a, Baton Rouge, LA 70816Certificate of waiverMar 11, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

11605 Southfork Ave
#A
Baton Rouge, LA 70816
Phone (225) 291-9421

12011 Bricksome Ave
Ste A
Baton Rouge, LA 70816
Phone (225) 291-9421

3049 S Sherwood Forest Blvd
Ste 100
Baton Rouge, LA 70816
Phone (225) 291-9421

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
The Summitt LLC Organization, Ridgeland, MS LLC, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2016 16.67%
QSST TR for Alison Beebe Sadler Danos and Her Descendants Organization, Ridgeland, MS 5% Or Greater Indirect Ownership Interest Jan 1, 2016 5.55%
Medico LLC Organization, Ridgeland, MS LLC, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2016 16.66%
Irrv Property TR for the Quirk Children Organization, Denham Springs, LA 5% Or Greater Direct Ownership Interest Jul 31, 2018 50%
Michele Browning Individual W-2 Managing EmployeeAdministrator Jan 4, 2021
Elton G Beebe Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2016 5.55%
Randelle R Freeze Individual W-2 Managing EmployeeAdministrator Feb 11, 2014
Toni H Parkinson Individual Corporate OfficerPres, Acct MGT SVCS Inc Oct 15, 2015
David W Stallard Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2016 16.67%
Operational/Managerial Control Apr 28, 2004
Bobby L Beebe Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2016 16.67%
Providence Care LLC Organization, Mandeville, LA LLC, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2016 16.67%
Operational/Managerial Control Apr 28, 2004
QSST TR for Felicia Beebe Stallard and Her Descendants Organization, Ridgeland, MS 5% Or Greater Indirect Ownership Interest Jan 1, 2016 5.55%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lifepath Hospice Care ServicesShreveport, LA, CCN 191574 Hospice 5% Or Greater Direct Ownership Interest (70%) Aug 1, 2004

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 41

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

  • Alexandria Healthcare LLC

    dba The Summit

    • Nursing Facility/Intermediate Care Facility
    • Alexandria, LA
    • NPI 1952354086

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Bossier Riverview LLC

    dba Riverview Care Center

    • Skilled Nursing Facility
    • Bossier City, LA
    • NPI 1992581961

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Colonial Oaks Care Center of Metairie

    dba Colonial Oaks Living Center

    • Skilled Nursing Facility
    • Metairie, LA
    • NPI 1497360432

    Irrv Property TR for the Quirk Children, Medico LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of Baton Rouge LLC

    dba Landmark South Nursing & Rehabilition Center

    • Skilled Nursing Facility
    • Baton Rouge, LA
    • NPI 1871541722

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of Covington LLC

    dba Forest Manor Nursing & Rehabilitation Center

    • Skilled Nursing Facility
    • Covington, LA
    • NPI 1942258876

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of Hammond LLC

    dba Landmark Nursing Center of Hammond

    • Skilled Nursing Facility
    • Hammond, LA
    • NPI 1073571212

    Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of Heritage House LLC

    dba Heritage Manor of Baton Rouge II

    • Skilled Nursing Facility
    • Baton Rouge, LA
    • NPI 1962469213

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of Houma LLC

    dba Heritage Manor Houma

    • Skilled Nursing Facility
    • Houma, LA
    • NPI 1407804362

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of Mandeville LLC

    dba Heritage Manor of Mandeville

    • Skilled Nursing Facility
    • Mandeville, LA
    • NPI 1679531362

    Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of Opelousas LLC

    dba Senior Village Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Opelousas, LA
    • NPI 1821056136

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of Shreveport South LLC

    dba Heritage Manor South

    • Skilled Nursing Facility
    • Shreveport, LA
    • NPI 1083662944

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
  • Community Care Center of St Martinville LLC

    dba Landmark of Acadiana

    • Skilled Nursing Facility
    • Saint Martinville, LA
    • NPI 1093773301

    Medico LLC, Providence Care LLC, QSST TR for Alison Beebe Sadler Danos and Her Descendants, QSST TR for Felicia Beebe Stallard and Her Descendants

    CMS ownership
View all 41

Practitioners & affiliated clinicians

Practitioners 11

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 10

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": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186444800000",
    "number": "1356309199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3049 S SHERWOOD FOREST BLVD",
            "address_2": "SUITE 100",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708162277",
            "telephone_number": "225-291-9421",
            "fax_number": "225-291-9743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3049 S SHERWOOD FOREST BLVD",
            "address_2": "SUITE 100",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708162277",
            "telephone_number": "225-291-9421",
            "fax_number": "225-291-9743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2007-08-07",
        "status": "A",
        "authorized_official_last_name": "BELTON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "601-709-1408",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "LA",
            "license": "148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Source Services Baton Rouge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.