NPIMap

Organization Active NPI

Community Bridges South, Inc.

Doing business as Dodson Community Residence

  • Intellectual Disabilities Intermediate Care Facility
  • Dodson, LA
National Provider Identifier
1649306127
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
597 Issued in LA
Legal business name
COMMUNITY BRIDGES SOUTH, INC.
Doing business as
Dodson Community Residence
Practice address
8804 Hwy 126
Dodson, LA 71422
Phone
(318) 255-9137
Fax
(318) 255-8233
NPI assigned
Feb 26, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Mike L. Reynolds
Title
Ceo
Phone
(318) 255-9137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 597 LA Primary

Addresses

Primary practice location

8804 Hwy 126
Dodson, LA 71422

Mailing address

PO Box 715
Ruston, LA 71273-0715
Phone (318) 255-9137

Other identifiers 1

IdentifierTypeStateIssuer
1718483MedicaidLA

Other names 1

  • Dodson Community Residence Doing business as

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
19D1096645Dodson Community Residence8804 Hwy #126, Dodson, LA 71422Certificate of waiverMar 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Bridges South14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

8804 Highway 126
Dodson, LA 71422
Phone (318) 255-9137

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649306127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 715",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712730715",
            "telephone_number": "318-255-9137",
            "fax_number": "318-255-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8804 HWY 126",
            "city": "DODSON",
            "state": "LA",
            "postal_code": "71422",
            "telephone_number": "318-255-9137",
            "fax_number": "318-255-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES SOUTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-255-9137",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1718483",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dodson Community Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dodson, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.