NPIMap

Organization Active NPI

St. Mary's Residential Community and Services

Doing business as Clarks Manor

  • Intellectual Disabilities Intermediate Care Facility
  • Boyce, LA
National Provider Identifier
1689244352
Registry record updated Apr 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ST. MARY'S RESIDENTIAL COMMUNITY AND SERVICES
Doing business as
Clarks Manor
Practice address
2003 Huie Dellmon Ave
Boyce, LA 71409-9328
Phone
(318) 445-6443
NPI assigned
Jun 25, 2021
Last updated
Apr 7, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. MARY'S RESIDENTIAL COMMUNITY AND SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2026

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

Authorized official

Name
Khristy Ellis
Title
Controller
Phone
(318) 445-6443

Specialties & licenses 1

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

Addresses

Primary practice location

2003 Huie Dellmon Ave
Boyce, LA 71409-9328

Mailing address

PO Box 7768
Alexandria, LA 71306-0768
Phone (318) 445-6443

Other identifiers 1

IdentifierTypeStateIssuer
MR0012749OtherLALOUISIANA DEPARTMENT OF HEALTH

Other names 1

  • Clarks Manor Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689244352. Details of each certification follow.

  • CCN 19G821 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G821

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
Clarks Manor
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 4, 2021
Last certification
Jul 16, 2025
Beds
8
Ownership / control type
Private (non-profit)
Facility address
2003 Huie-Dellmon Avenue
Boyce, LA 71409

National Provider Directory

National Provider Directory
Tax ID family
St Mary's Residential Community and Services27 organizations share this tax ID, including this one
Part of
St Mary's Residential Community and Services

Other organizations with this tax ID 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775520000000",
    "number": "1689244352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7768",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713060768",
            "telephone_number": "318-445-6443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 HUIE DELLMON AVE",
            "city": "BOYCE",
            "state": "LA",
            "postal_code": "714099328",
            "telephone_number": "318-445-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S RESIDENTIAL COMMUNITY AND SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S RESIDENTIAL COMMUNITY AND SERVICES",
        "enumeration_date": "2021-06-25",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "KHRISTY",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "318-445-6443"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOUISIANA DEPARTMENT OF HEALTH",
            "identifier": "MR0012749",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarks Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boyce, LA

Sources for this page

Verify at the official NPI Registry.