Community Care Center of Louisiana, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

033696 Issued in MO

Legal business name

COMMUNITY CARE CENTER OF LOUISIANA, INC

Doing business as

Maple Grove Lodge

Practice address

2407 Kentucky Street
Louisiana, MO 63353-2503

Phone

(573) 754-5456

Fax

(573) 754-6624

NPI assigned

Jun 30, 2005

Organization subpart

No

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

Authorized official

Name

Christina M Giardina

Title

President

Phone

(636) 394-3000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Maple Grove Lodge Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Manuel Le-Yeng San, D.O.

  • Family Medicine Physician
  • Columbia, MO
  • NPI 1245443548
  NPD (past)

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1477550911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 SOVEREIGN CT",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114432",
            "telephone_number": "366-394-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 KENTUCKY STREET",
            "city": "LOUISIANA",
            "state": "MO",
            "postal_code": "633532503",
            "telephone_number": "573-754-5456",
            "fax_number": "573-754-6624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE CENTER OF LOUISIANA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "GIARDINA",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "636-394-3000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "033696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102299302",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Grove Lodge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maple Grove Lodge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Helm Branstetter, M.A., CCC-SLP
• Austin Arness Brown, P.T., D.P.T.
• Kaitlyn Rose Burnett
• Jennifer Leigh Chandler, APRN, FNP-BC
• Clarksville Chiropractic Center, PC (Chiropractic Health Center)
• Patrick Joseph Cuppy
• DBB Pharmacies, Inc (Best Buy Pharmacy of Louisiana)
• Tara Dickherber, LPC
• Michelle Drakesmith
• Edward a. Cline, DPM, PC

• Skilled Nursing Facility in Louisiana, MO
• Providers in Louisiana, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.

Verify at the official NPI Registry.