NPIMap

CLHG-Dequincy, LLC

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Dequincy, LA

NPI 1447813191 · NPPES record last updated Apr 18, 2019

Key facts

NPI
1447813191
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
Legal business name
CLHG-DEQUINCY, LLC
Practice address
110 W 4TH St
Dequincy, LA 70633-3508
Phone
(337) 786-1200
Fax
(337) 786-1219
NPI assigned
Apr 18, 2019
Organization subpart
Yes
Parent organization (as reported)
CLHG-DEQUINCY, LLC

Authorized official

Name
Jeried H. Hairgrove
Title
Ceo-Administrator
Phone
(337) 375-5997

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 4

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 48

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

View all 48

Affiliated clinicians 1

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Hospital certification: CCN 19Z307

Legal name
CLHG-DEQUINCY, LLC
Doing business as
DEQUINCY MEMORIAL HOSPITAL
Organization structure
LLC · Proprietary
Incorporated
in LA
Enrollment address
110 W 4TH St
Dequincy, LA 70633-3508
Hospital Swing-Bed Unit

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Donald Cameron
Individual 		Corporate Officer
Board Member		 Apr 1, 2019
Corporate Director
Board Member		 Apr 1, 2019
Operational/Managerial Control
Board Member		 Apr 1, 2019
Rock Bordelon
Individual 		5% Or Greater Direct Ownership Interest
Owner, Board Member		 Apr 1, 2019 100%
Corporate Director
Owner, Board Member		 Apr 1, 2019
Operational/Managerial Control
Owner, Board Member		 Apr 1, 2019
Allegiance Health Management Inc
Organization · Bossier City, LA
Corporation 		Operational/Managerial Control Apr 1, 2019
Brenda Cooley
Individual 		W-2 Managing Employee
Business Office Manager		 Apr 1, 2019
Vicky Kelley
Individual 		Corporate Officer
Cfo		 Jan 1, 2023
Karen L Strickland
Individual 		Corporate Officer
Ceo		 Apr 1, 2019
W-2 Managing Employee Apr 1, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190520000977 LA Part a Provider - Critical Access Hospital 4385987106 Practice locations: Dequincy, LA

National Provider Directory

Tax ID family
CLHG-Dequincy LLC (5 organizations share this tax ID)
Part of
CLHG-Dequincy LLC

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Yes

Addresses

Primary practice location

110 W 4TH St
Dequincy, LA 70633-3508

Mailing address

PO Box 1166
Dequincy, LA 70633-1166
Phone (337) 786-1200

Other names

  • Dequincy Memorial Hospital Doing business as

Other providers in Dequincy, LA

All providers in Dequincy, LA · Medicare Defined Swing Bed Hospital Unit in Louisiana

Sources for this page

Verify at the official NPI Registry.