NPIMap

Organization Active NPI

Mangham Home Care Inc

  • Home Health Agency
  • Mangham, LA
National Provider Identifier
1720006679
Registry record updated Feb 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
377 Issued in 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
Last updated
Feb 11, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2009

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

Authorized official

Name
Mrs. Ida B Gilley
Title
Administrator
Phone
(318) 248-2797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 377 LA Primary

Addresses

Primary practice location

714 Broadway
Mangham, LA 71259

Mailing address

PO Box 427
714 Broadway
Mangham, LA 71259
Phone (318) 248-2797

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081119000184 LA Part A Provider - Home Health Agency 1153481213 Practice locations: Mangham, LA; Monroe, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720006679. Details of each certification follow.

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
OtherProprietary
Incorporated
Jan 28, 1991 in LA
Enrollment address
714 Broadway St
Mangham, LA 71259-5004

Care Compare: Home health agency

Medicare Care Compare
Listed as
Mangham Home Care, Inc.CCN 197295 · All quality measures
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Feb 4, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Mangham Home Care4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1867 Avenue of America
Ste C
Monroe, LA 71201
Phone (318) 329-8980

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Judy Gilley Individual 5% Or Greater Direct Ownership InterestDirector Apr 22, 2003 0.25%
Corporate OfficerPresident Feb 27, 2018 0.25%
W-2 Managing Employee Apr 22, 2003
Connie Gill Individual 5% Or Greater Direct Ownership InterestDirector Oct 26, 2007 0.25%
General Partnership InterestBoard Member Director Feb 27, 2018 25%
Corporate OfficerBoard Member Feb 27, 2018 25%
Corporate DirectorVP Feb 27, 2018 25%
W-2 Managing EmployeeVice President Feb 27, 2018 25%
Krystal G Fleming Individual 5% Or Greater Direct Ownership InterestDirector Feb 27, 2018 0.25%
General Partnership InterestDirector/ Board Member Feb 27, 2018 25%
Corporate OfficerSecretary Feb 27, 2018 0.25%
Corporate DirectorBoard Member Feb 27, 2018 25%
W-2 Managing EmployeeSecretary Feb 27, 2018 0.25%
Colby R Gill Individual 5% Or Greater Direct Ownership InterestDirector Feb 27, 2018 0.25%
General Partnership InterestDirector / Board Member Cfo Feb 27, 2018 0.25%
Corporate OfficerTreasurer Feb 27, 2018 0.25%

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234310400000",
    "number": "1720006679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 427",
            "address_2": "714 BROADWAY",
            "city": "MANGHAM",
            "state": "LA",
            "postal_code": "71259",
            "telephone_number": "318-248-2797",
            "fax_number": "318-248-3536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 BROADWAY",
            "city": "MANGHAM",
            "state": "LA",
            "postal_code": "71259",
            "telephone_number": "318-248-2797",
            "fax_number": "318-248-3536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGHAM HOME CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2009-02-11",
        "status": "A",
        "authorized_official_last_name": "GILLEY",
        "authorized_official_first_name": "IDA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-248-2797",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "LA",
            "license": "377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mangham, LA

Sources for this page

Verify at the official NPI Registry.