NPIMap

Organization Active NPI

Primestar Home Health

  • Home Health Agency
  • Rayville, LA
National Provider Identifier
1386647659
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
390 Issued in LA
Legal business name
PRIMESTAR HOME HEALTH
Practice address
1008 Julia St
Rayville, LA 71269
Phone
(318) 329-8292
Fax
(318) 490-4364
NPI assigned
May 31, 2005
Last updated
Jul 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Authorized official

Name
Mrs. Tiffany A Castleman, RN, HCS-C
Title
Administrator
Phone
(318) 259-1410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 390 LA Primary

Addresses

Primary practice location

1008 Julia St
Rayville, LA 71269

Mailing address

235 Desiard St.
Monroe, LA 71201
Phone (318) 329-8292

Other practice location 1

235 Desiard St.
Monroe, LA 71201
Phone (318) 329-8292

Other practice location 2

310 S Chestnut St
Tallulah, LA 71282-4206
Phone (318) 329-8292

Other identifiers 1

IdentifierTypeStateIssuer
1401609MedicaidLA

Other names 1

  • Haworth Home Health, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080716000213 LA Part A Provider - Home Health Agency 6507939170 Practice locations: Monroe, LA; Rayville, LA; Tallulah, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386647659. Details of each certification follow.

Home health agency certification: CCN 197426

Legal name
PRIMESTAR HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 10, 1991
Last certification
Feb 12, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
May 16, 2019 in LA
Enrollment address
1008 Julia St
Rayville, LA 71269-2603
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Primestar Home Health IncCCN 197426 · All quality measures
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Nov 10, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

235 Desiard St
Monroe, LA 71201
Phone (318) 329-8292

301 Hudson Ln
Monroe, LA 71201
Phone (318) 329-8292

504 Bres Ave
Monroe, LA 71201

310 S Chestnut St
Tallulah, LA 71282
Phone (318) 329-8292

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
James Barnette Individual 5% Or Greater Direct Ownership InterestCeo May 15, 2019 100%
Corporate DirectorCeo May 15, 2019 70.1%
Tiffany Castleman Individual Operational/Managerial ControlAdmin May 20, 2019 10.1%

Practitioners & affiliated clinicians

Affiliated clinicians 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594684800000",
    "number": "1386647659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 DESIARD ST.",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71201",
            "telephone_number": "318-329-8292",
            "fax_number": "318-490-4364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 JULIA ST",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "71269",
            "telephone_number": "318-329-8292",
            "fax_number": "318-490-4364"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "235 Desiard St.",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "71201",
            "country_code": "US",
            "telephone_number": "318-329-8292",
            "fax_number": "318-490-4364",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 S Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Tallulah",
            "state": "LA",
            "postal_code": "712824206",
            "country_code": "US",
            "telephone_number": "318-329-8292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIMESTAR HOME HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A",
        "authorized_official_last_name": "CASTLEMAN",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-259-1410",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, HCS-C"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "LA",
            "license": "390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1401609",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haworth Home Health, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rayville, LA

Sources for this page

Verify at the official NPI Registry.