Winn Community Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Pineville, LA
NPI 1497377337 · NPPES record last updated May 14, 2020
Key facts
- NPI
- 1497377337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- WINN COMMUNITY HEALTH CENTER, INC.
- Practice address
- 1511 Line St
Pineville, LA 71360-5033 - Phone
- (318) 648-0375
- NPI assigned
- May 14, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- WINN COMMUNITY HEALTH CENTER, INC.
Authorized official
- Name
- David Adams
- Title
- Coo
- Phone
- (318) 648-0375
Corporate family (same tax ID) 24
Practitioners 11
-
Kristen Bordelon Jeansonne, NURSE PRACTITIONER
-
Lauren E Johnson, MSN, APRN, FNP-C
-
Tamara Dianne McAdams, NP-C
-
Monte Dale Moore, APRN
-
Mallorie McDowell Parham, PA-C
-
Shane Louis Pennison, APRN, FNP-C
-
Anastasia Marie Guillory Roy, APRN, FNP-C
-
Stephanie L Simmons, RN, MSN, APRN,FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Federally qualified health center certification: CCN 191040
- Legal name
- WINN COMMUNITY HEALTH CENTER, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 17, 2020
- Last certification
- Jul 17, 2020
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 1, 2020 in LA
- Enrollment address
- 1511 Line St
Pineville, LA 71360-5033
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Deano Thornton |
5% Or Greater Direct Ownership Interest | Jun 15, 2009 | |
| W-2 Managing Employee | Jun 15, 2009 | ||
| Glenda Melton |
Corporate Director | Jan 1, 2015 | |
| Betty Ashley |
Corporate Director | Mar 1, 2009 | |
| Brent Hubbard |
Corporate Director | Sep 1, 2012 | |
| Cynthia Jamison |
Corporate Director | Jan 1, 2015 | |
| Charlie Jurek |
Corporate Director | Jun 15, 2009 | |
| June Melton |
Corporate Director | Jul 1, 2009 | |
| Brenda Jones |
Corporate Director | Feb 1, 2013 | |
| Joe Bass |
Corporate Director | Jun 15, 2009 | |
| Stanley King |
Corporate Director | Jul 1, 2009 | |
| Matthew Walton |
Corporate Director | Feb 1, 2016 |
All facility ownership & control disclosures 22
| Facility | Type | Role | Since |
|---|---|---|---|
| Grant Community Health Center |
Federally qualified health center | Operational/Managerial Control | Feb 24, 2014 |
| Bienville Community Health Center |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2015 |
| Winn Community Health Center, Inc. |
Federally qualified health center | Operational/Managerial Control | Apr 1, 2017 |
| Winn Community Health Center, Inc. |
Federally qualified health center | Operational/Managerial Control | Jul 17, 2017 |
| Rapides Academy School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Cherokee Elementary School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Tioga Elementary School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Hayden R Lawrence Upper Esbc |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Oak Hill High School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Forest Hill Jr High School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Poland Jr. High School Based Clinic |
Federally qualified health center | Operational/Managerial Control | May 25, 2022 |
| Plainview High School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Ball Elementary School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Rapides High School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2019 |
| Carter C. Raymond Elementary School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Alma Redwine Esbc |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Paradise Esbc |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Ruby Wise Elementary SBC |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Mary Goff Elementary SBC |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| South Grant Community Health Center |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Winnfield Physical Therapy |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
| Montgomery Community Health Center |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2009 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200720000835 | LA | Part a Provider - Federally Qualified Health Center (FQHC) | 2567516545 | Practice locations: Pineville, LA |
National Provider Directory
- Tax ID family
- Winn Comm HLTH Ctr Inc
- Part of
- Winn Comm HLTH Ctr Inc
Locations
3348 Highway 457
Alexandria, LA 71302
5010 Monroe Hwy
Ball, LA 71405
Phone (318) 693-1314
4855 Highway 10
Elizabeth, LA 70638
403 W South Ave
Winnfield, LA 71483
Phone (318) 302-3263
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1511 Line St
Pineville, LA 71360-5033
Mailing address
PO Box 1288
Winnfield, LA 71483-1288
Phone (318) 209-4910
Other names
- Pineville High School Based Clinic
Other providers in Pineville, LA
- John Rivers Wilson
- Leonard C Wilson
- Marley Elizabeth Wilson
- Angela Winke
- Winn Community Health Center, Inc.
- Winn Community Health Center, Inc.
- Winn Community Health Center, Inc.
- Winn Community Health Center, Inc.
- Shannon D Wise
- Shawanda Woods
All providers in Pineville, LA · Federally Qualified Health Center (FQHC) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.