Active NPI
Avalon Place, LP
Doing business as Avalon Place
- Nursing Facility Supplies (DME)
- Monroe, LA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility Supplies (DME)
- Legal business name
- AVALON PLACE, LP
- Doing business as
- Avalon Place
- Practice address
- 4385 Old Sterlington Rd
Monroe, LA 71203-2360 - Phone
- (318) 322-2000
- Fax
- (318) 812-2143
- NPI assigned
- Aug 5, 2006
- Last updated
- Feb 14, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Dawne R Smith
- Title
- Ceo
- Phone
- (318) 812-2140
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 435 | LA | |
| Nursing Facility Supplies (DME) | 332BN1400X | Primary | ||
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X |
Addresses
Primary practice location
4385 Old Sterlington Rd
Monroe, LA 71203-2360
Mailing address
4385 Old Sterlington Rd
Monroe, LA 71203-2360
Phone (318) 322-2000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3965490001 | Other | LA | PALMETTO GBA DMERC |
| 1521094 | Medicaid | LA |
Other names 1
- Avalon Place
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040123000059 | LA | Part A Provider - Skilled Nursing Facility | 0143122846 | Practice locations: Monroe, LA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1396754750. Details of each certification follow.
Skilled nursing facility certification: CCN 195492
- Legal name
- AVALON PLACE, LP
- Doing business as
- AVALON PLACE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 24, 2000
- Last certification
- Oct 16, 2024
- Beds
- 113
- Ownership / control type
- Partnership
- Multi-facility organization
- Paramount Healthcare Consultants
- Organization structure
- Partnership
- Enrollment address
- 4385 Old Sterlington Rd
Monroe, LA 71203-2360 - Nursing home name
- AVALON PLACE
- Affiliated entity
- PARAMOUNT HEALTHCARE CONSULTANTS
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Avalon Place
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Partnership
- Certified
- Jul 24, 2000
- Medicare certification status
- Active
- Certified beds
- 113
- Chain
- Paramount Healthcare Consultants
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D0958625 | Avalon Place | Certificate of waiver | Mar 22, 2027 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 11
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| DCZ Healthcare Investments, LLC | Direct Ownership Interest | Jan 1, 2008 | 24% |
| Stephen Duck, Cpa PC | Adp of the SNF | Jan 1, 2018 | |
| Paramount Healthcare Consultants, LLC | Adp of the SNF | Jan 1, 2008 | |
| DCZ1 Ventures LLC | 5% Or Greater Mortgage Interest | Jan 1, 2008 | 25% |
| Adp of the SNF | Jan 1, 2008 | ||
| Kelly Coburn | 5% Or Greater Indirect Ownership Interest | Jan 1, 2008 | 50% |
| Adp of the SNF | Jan 1, 2008 | ||
| Matthew Randall Hall | Operational/Managerial Control | Feb 1, 2021 | |
| Adp of the SNF | Feb 1, 2021 | ||
| Avalon Place Property, LLC | 5% Or Greater Mortgage Interest | Jan 1, 2008 | 100% |
| Adp of the SNF | Jan 1, 2008 | ||
| PKC Investments, LLC | 5% Or Greater Mortgage Interest | Jan 1, 2008 | 75% |
| Adp of the SNF | Jan 1, 2008 | ||
| Direct Ownership Interest | Jan 1, 2008 | 73% | |
| Dawne R Smith | 5% Or Greater Indirect Ownership Interest | Jan 1, 2008 | 100% |
| Adp of the SNF | Jan 1, 2008 | ||
| Paul B Coburn | 5% Or Greater Indirect Ownership Interest | Jan 1, 2008 | 50% |
| Adp of the SNF | Jan 1, 2008 | ||
| Amin M El Malah | Adp of the SNF | Jan 1, 2002 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Practitioners 4
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.
-
- Internal Medicine Physician
- Monroe, LA
- NPI 1760418628
-
- Family Medicine Physician
- Monroe, LA
- NPI 1922034487
-
- Family Medicine Physician
- Bernice, LA
- NPI 1205047610
-
- Family Medicine Physician
- West Monroe, LA
- NPI 1598738049
Affiliated clinicians 3
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": "1154736000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1392336000000",
"number": "1396754750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4385 OLD STERLINGTON RD",
"city": "MONROE",
"state": "LA",
"postal_code": "712032360",
"telephone_number": "318-322-2000",
"fax_number": "318-812-2143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4385 OLD STERLINGTON RD",
"city": "MONROE",
"state": "LA",
"postal_code": "712032360",
"telephone_number": "318-322-2000",
"fax_number": "318-812-2143"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVALON PLACE, LP",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-05",
"last_updated": "2014-02-14",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "DAWNE",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "318-812-2140",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "LA",
"license": "435",
"primary": false
},
{
"code": "332BN1400X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
"state": null,
"license": null,
"primary": true
},
{
"code": "332BP3500X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA DMERC",
"identifier": "3965490001",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1521094",
"state": "LA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Avalon Place",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.