NPIMap

Organization Active NPI

Louise S Davis Residential Facilities, LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Shreveport, LA
National Provider Identifier
1720104466
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
970 Issued in LA
Legal business name
LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC
Practice address
1411 Claiborne Ave
Shreveport, LA 71103-4203
Phone
(337) 439-6600
Fax
(337) 439-6647
NPI assigned
Mar 22, 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
Kendall A Broussard
Title
Managing Member
Phone
(337) 439-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 970 LA Primary

Addresses

Primary practice location

1411 Claiborne Ave
Shreveport, LA 71103-4203

Mailing address

1 Lakeshore Dr
Suite 1900
Lake Charles, LA 70629-0100
Phone (337) 439-6600

Other identifiers 1

IdentifierTypeStateIssuer
1710971MedicaidLA

Other names 1

  • IVY GROUP HOME Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Louise S Davis Residential Facilities LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720104466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LAKESHORE DR",
            "address_2": "SUITE 1900",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706290100",
            "telephone_number": "337-439-6600",
            "fax_number": "337-439-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 CLAIBORNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034203",
            "telephone_number": "337-439-6600",
            "fax_number": "337-439-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "337-439-6600"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "LA",
            "license": "970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710971",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IVY GROUP HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.