NPIMap

Organization Active NPI

CLHG-Dequincy, LLC

  • Psychiatric Hospital Unit
  • Dequincy, LA
National Provider Identifier
1538722285
Registry record updated Apr 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
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
CLHG-DEQUINCY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 18, 2019

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

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 1

  • Dequincy Memorial Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190520001171 LA Part A Provider - Critical Access Hospital 4385987106 Practice locations: Dequincy, LA

Hospital certification: CCN 19M307

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

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Dequincy LLC5 organizations share this tax ID, including this one
Part of
CLHG-Dequincy LLC

Other organizations with this tax ID 4

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

Ownership & related parties

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 OfficerBoard Member Apr 1, 2019
Corporate DirectorBoard Member Apr 1, 2019
Operational/Managerial ControlBoard Member Apr 1, 2019
Rock Bordelon Individual 5% Or Greater Direct Ownership InterestOwner, Board Member Apr 1, 2019 100%
5% Or Greater Indirect Ownership Interest Apr 1, 2019 100%
Corporate DirectorBoard Member Apr 1, 2019
Operational/Managerial ControlOwner, 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 EmployeeBusiness Office Manager Apr 1, 2019
Vicky Kelley Individual Corporate OfficerCfo Jan 1, 2023
Karen L Strickland Individual Corporate OfficerCeo Apr 1, 2019
W-2 Managing Employee Apr 1, 2019

Facilities with the same owner 48

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

View all 48

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555545600000",
    "number": "1538722285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1166",
            "city": "DEQUINCY",
            "state": "LA",
            "postal_code": "706331166",
            "telephone_number": "337-786-1200",
            "fax_number": "337-786-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W 4TH ST",
            "city": "DEQUINCY",
            "state": "LA",
            "postal_code": "706333508",
            "telephone_number": "337-786-1200",
            "fax_number": "337-786-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-DEQUINCY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLHG-DEQUINCY, LLC",
        "enumeration_date": "2019-04-18",
        "last_updated": "2019-04-18",
        "status": "A",
        "authorized_official_last_name": "HAIRGROVE",
        "authorized_official_first_name": "JERIED",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "CEO-ADMINISTRATOR",
        "authorized_official_telephone_number": "337-375-5997"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dequincy Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dequincy, LA

Sources for this page

Verify at the official NPI Registry.