NPIMap

Organization Active NPI

Community Bridges South, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Ruston, LA
National Provider Identifier
1679609069
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
1034 Issued in LA
Legal business name
COMMUNITY BRIDGES SOUTH, INC.
Doing business as
Lilinda Community Residence
Practice address
2600 S Vienna St
Ruston, LA 71270-9026
Phone
(318) 255-1937
Fax
(318) 255-8233
NPI assigned
Feb 27, 2007
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) 255-1937

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 1034 LA Primary

Addresses

Primary practice location

2600 S Vienna St
Ruston, LA 71270-9026

Mailing address

2600 S Vienna St
Ruston, LA 71270-9026
Phone (318) 255-1937

Other identifiers 1

IdentifierTypeStateIssuer
1710334MedicaidLA

Other names 1

  • Lilinda Community Residence Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G186

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Lilinda Street Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 1, 1985
Last certification
May 8, 2025
Beds
8
Ownership / control type
Private (proprietary)
Most recent change of ownership
Jul 1, 2006
Facility address
2600 South Vienna
Ruston, LA 71270

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
19D1045385Community Bridges South Lilinda Community2600 South Vienna, Ruston, LA 71270Certificate of waiverSep 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Bridges South Inc14 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

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679609069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 S VIENNA ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712709026",
            "telephone_number": "318-255-1937",
            "fax_number": "318-255-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S VIENNA ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712709026",
            "telephone_number": "318-255-1937",
            "fax_number": "318-255-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES SOUTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "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": "318-255-1937",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "1034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710334",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lilinda Community Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

Sources for this page

Verify at the official NPI Registry.