NPIMap

Organization Active NPI

CLHG-Ville Platte LLC

Doing business as Mercy Rural Clinic

  • Rural Health Clinic/Center
  • Ville Platte, LA
National Provider Identifier
1639720493
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLHG-VILLE PLATTE LLC
Doing business as
Mercy Rural Clinic
Practice address
899 E Lasalle St
Ville Platte, LA 70586-4001
Phone
(337) 506-2255
Fax
(337) 506-2288
NPI assigned
Sep 24, 2019
Last updated
Jul 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

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

Authorized official

Name
Kristopher Aguillard
Title
Ceo
Phone
(337) 459-5623

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

899 E Lasalle St
Ville Platte, LA 70586-4001

Mailing address

899 E Lasalle St
Ville Platte, LA 70586-4001
Phone (337) 506-2255

Other names 1

  • Mercy Rural Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200910002910 LA Part A Provider - Rural Health Clinic 4486903309 Practice locations: Ville Platte, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639720493. Details of each certification follow.

Rural health clinic certification: CCN 198523

Legal name
CLHG-VILLE PLATTE LLC
Doing business as
MERCY RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 10, 2020
Last certification
Jun 10, 2020
Ownership / control type
1B
Most recent change of ownership
Aug 1, 2020 (1 total)
Organization structure
LLCProprietary
Enrollment address
899 E Lasalle St
Ville Platte, LA 70586-4001
Related CCNs
190106

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

Other NPIs with the same Medicare PAC ID 8

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2292935Mercy Rural Health Clinic899 E Lasalle Street, Ville Platte, LA 70586Certificate of waiverOct 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Ville Platte LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

411 E Main St
Ville Platte, LA 70586
Phone (337) 506-2255

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Aug 1, 2020 65%
Allegiance Health Management Inc Organization, Bossier City, LA Corporation Limited Partnership Interest Aug 1, 2018
Operational/Managerial Control Aug 1, 2020
Kevin Ardoin Individual Corporate OfficerCeo Jan 1, 2026 100%
W-2 Managing EmployeeCeo Jan 1, 2026 100%
Scott Markstrom Individual 5% Or Greater Direct Ownership InterestOwner Mar 1, 2020 8%
Cameron Investments LLC Organization, Shreveport, LA LLC 5% Or Greater Direct Ownership Interest Aug 1, 2020 27%

Facilities with the same owner 53

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

View all 53

Change-of-ownership history 2

DateEventCounterparty
Aug 1, 2020 Change of OwnershipThis provider was the buyer Evangeline PediatricsCCN 198523, LA, NPI 1639720493
Aug 1, 2020 Change of OwnershipThis provider was the seller Mercy Rural Health ClinicCCN 198523, LA, NPI 1639720493

NPI Registry JSON

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690329600000",
    "number": "1639720493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "899 E LASALLE ST",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "705864001",
            "telephone_number": "337-506-2255",
            "fax_number": "337-506-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "899 E LASALLE ST",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "705864001",
            "telephone_number": "337-506-2255",
            "fax_number": "337-506-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-VILLE PLATTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-24",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A",
        "authorized_official_last_name": "AGUILLARD",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-459-5623"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Rural Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ville Platte, LA

Sources for this page

Verify at the official NPI Registry.