Mangham Home Care Inc
Organization Active NPI Home Health Agency · Mangham, LA
NPI 1720006679 · NPPES record last updated Feb 11, 2009
Key facts
- NPI
- 1720006679
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 377 (LA)
- Legal business name
- MANGHAM HOME CARE INC
- Practice address
- 714 Broadway
Mangham, LA 71259 - Phone
- (318) 248-2797
- Fax
- (318) 248-3536
- NPI assigned
- Jul 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Ida B Gilley
- Title
- Administrator
- Phone
- (318) 248-2797
Corporate family (same tax ID) 3
Affiliated clinicians 7
-
Kyle Bruyninckx, MD
-
Thomas L Colvin, MD
-
Jimmy R Coughran, MD
-
Kelly Reed Lodgen, M.D.
-
Charles E Reed, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Mangham Home Care, Inc.
- Overall star rating
- ★★☆☆☆ 2 of 5
- Ownership
- Proprietary
- Certified
- Feb 4, 1991
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Home health agency certification: CCN 197295
- Legal name
- MANGHAM HOME CARE INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 4, 1991
- Last certification
- Feb 25, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Other · Proprietary
- Incorporated
- Jan 28, 1991 in LA
- Enrollment address
- 714 Broadway St
Mangham, LA 71259-5004
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Judy Gilley |
5% Or Greater Direct Ownership Interest |
Apr 22, 2003 | 0.25% |
| Corporate Officer |
Feb 27, 2018 | 0.25% | |
| W-2 Managing Employee | Apr 22, 2003 | ||
| Connie Gill |
5% Or Greater Direct Ownership Interest |
Oct 26, 2007 | 0.25% |
| General Partnership Interest |
Feb 27, 2018 | 25% | |
| Corporate Officer |
Feb 27, 2018 | 25% | |
| Corporate Director |
Feb 27, 2018 | 25% | |
| W-2 Managing Employee |
Feb 27, 2018 | 25% | |
| Krystal G Fleming |
5% Or Greater Direct Ownership Interest |
Feb 27, 2018 | 0.25% |
| General Partnership Interest |
Feb 27, 2018 | 25% | |
| Corporate Officer |
Feb 27, 2018 | 0.25% | |
| Corporate Director |
Feb 27, 2018 | 25% | |
| W-2 Managing Employee |
Feb 27, 2018 | 0.25% | |
| Colby R Gill |
5% Or Greater Direct Ownership Interest |
Feb 27, 2018 | 0.25% |
| General Partnership Interest |
Feb 27, 2018 | 0.25% | |
| Corporate Officer |
Feb 27, 2018 | 0.25% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081119000184 | LA | Part a Provider - Home Health Agency | 1153481213 | Practice locations: Mangham, LA; Monroe, LA |
National Provider Directory
- Tax ID family
- Mangham Home Care
Locations
1867 Avenue of America
Ste C
Monroe, LA 71201
Phone (318) 329-8980
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 377 | LA | Yes |
Addresses
Primary practice location
714 Broadway
Mangham, LA 71259
Mailing address
PO Box 427
714 Broadway
Mangham, LA 71259
Phone (318) 248-2797
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1402818 | Medicaid | LA |
Other providers in Mangham, LA
- Hospital Service District No 1-a of the Parish of Richland State of la
- Terri Lynn Klick
- Christopher Blake Leblanc
- Mason Copeland Liles
- Mangham Home Care
- Mangham Home Care, Inc
- Mangham Home Care, Inc.
- Mangham RX Drugs, Inc
- Monroe Surgical Hospital, LLC
- Monroe Surgical Hospital, LLC
All providers in Mangham, LA · Home Health Agency in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.