Bogalusa Restoration Center, LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

BOGALUSA RESTORATION CENTER, LLC

Practice address

1640 S Columbia St
Bogalusa, LA 70427-5800

Phone

(985) 241-5340

Fax

(985) 241-5341

NPI assigned

Sep 13, 2018

Last updated

Nov 14, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Reiling, MSS,CP

Title

Chief Strategic Officer

Phone

(985) 241-5340

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487137626. Details of each certification follow.

• CCN 19L006 Psychiatric residential treatment facility · Active · Name & address match · Details

Psychiatric residential treatment facility certification: CCN 19L006

Legal name

BOGALUSA RESTORATION CENTER

Certification status

Active

Provider type (POS)

Psychiatric residential treatment facility

Participating since

Nov 29, 2018

Last certification

Apr 8, 2021

Beds

32

Ownership / control type

Non-profit – corporation

Facility address

1640 S Columbia Street, Suite a
Bogalusa, LA 70427

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542153600000",
    "number": "1487137626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 S COLUMBIA ST",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704275800",
            "telephone_number": "985-241-5340",
            "fax_number": "985-241-5341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 S COLUMBIA ST",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704275800",
            "telephone_number": "985-241-5340",
            "fax_number": "985-241-5341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOGALUSA RESTORATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-13",
        "last_updated": "2018-11-14",
        "status": "A",
        "authorized_official_last_name": "REILING",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CHIEF STRATEGIC OFFICER",
        "authorized_official_telephone_number": "985-241-5340",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSS,CP"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bogalusa Rehabilitation Hospital LLC (Bogalusa Rehabilitation Hospital)
• Bogue Chitto Heights Baptist Church, Inc (The Way Center)
• Barry Warris Bolton
• Carly Kristin Bordelon, PHARM.D.
• Randy Peter Bouligny, MD
• Darby Ann Bourgeois, LPN CPSS

• Psychiatric Residential Treatment Facility in Bogalusa, LA
• Providers in Bogalusa, LA by specialty
• Psychiatric Residential Treatment Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.