NPIMap

Organization Active NPI

Southwest Louisiana Hospital Association Inc

Doing business as Lake Charles Memorial Hospital

  • Psychiatric Hospital Unit
  • Lake Charles, LA
National Provider Identifier
1679637805
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC
Doing business as
Lake Charles Memorial Hospital
Practice address
1701 Oak Park Blvd
Lake Charles, LA 70601-8911
Phone
(337) 494-3000
NPI assigned
Dec 21, 2006
Last updated
Dec 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Authorized official

Name
Dawn Johnson-Hatcher
Title
Cfo
Phone
(337) 494-2094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU Primary

Addresses

Primary practice location

1701 Oak Park Blvd
Lake Charles, LA 70601-8911

Mailing address

PO Box 123977, Dept 3977
Dallas, TX 75312-0001
Phone (337) 480-7800

Other practice location 1

6713 Nelson Rd
Lake Charles, LA 70605-0475
Phone (337) 494-3000

Other identifiers 3

IdentifierTypeStateIssuer
60924OtherLABLUE CROSS - PSYCH
17205578MedicaidLA
60963OtherLABLUE CROSS CDU

Other names 1

  • Lake Charles 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
O20080603000604 LA Part A Provider - Hospital 3274427695 Practice locations: Lake Charles, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679637805. Details of each certification follow.

Hospital certification: CCN 19S060

Legal name
SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC
Doing business as
LAKE CHARLES MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
1701 Oak Park Blvd
Lake Charles, LA 70601-8911
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
William G Hebert16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Joseph Miller Individual Corporate DirectorBoard Member Apr 1, 2018 100%
Neil Aspinwall Individual Corporate DirectorBoard Member Jan 1, 2019
Amanda E Ellington Individual Corporate OfficerBoard Member Jan 1, 2022
Mitchell Adrian Individual Corporate DirectorBoard Member Apr 1, 2018 100%
Southwest Louisiana Hospital Association Inc Organization, Lake Charles, LA Corporation 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Benjamin Martin Azevedo Individual Corporate OfficerBoard Member Jan 1, 2023
Joseph Gregory Lugo Individual Corporate OfficerBoard Member Jan 1, 2021
Edward Carl Bergen Individual Corporate OfficerBoard Member Jan 1, 2022
William R Condos Individual Corporate DirectorBoard Member Apr 1, 2018 100%
Dawn Johnson Individual Corporate OfficerCfo Apr 9, 2021
Operational/Managerial Control Apr 9, 2021
Ulysses Thibodeaux Individual Corporate DirectorBoard Member Jan 1, 2014
Denise E Rau Individual Corporate DirectorBoard Member Apr 1, 2018 100%
James Devon Hyde Individual Corporate Officer Apr 12, 2021
Louis Todd Individual Corporate DirectorBoard Member Jan 1, 2014
Daniel T Hall Individual Corporate OfficerBoard Member Jan 1, 2021

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lake Charles Memorial HospitalLake Charles, LA, CCN 19T060 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2014
Home Health Agency of Lake Charles Memorial HospitalLake Charles, LA, CCN 197005 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 7, 1973
Iowa Health CenterIowa, LA, CCN 193408 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jun 1, 2010

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1679637805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123977, DEPT 3977",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753120001",
            "telephone_number": "337-480-7800",
            "fax_number": "337-474-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 OAK PARK BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018911",
            "telephone_number": "337-494-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6713 Nelson Rd",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706050475",
            "country_code": "US",
            "telephone_number": "337-494-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-HATCHER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-494-2094"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - PSYCH",
            "identifier": "60924",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17205578",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS CDU",
            "identifier": "60963",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Charles Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Charles Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.