NPIMap

Organization Active NPI

CLHG-Oakdale, LLC

Doing business as Oakdale Express Care

  • Rural Health Clinic/Center
  • Oakdale, LA
National Provider Identifier
1730628975
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLHG-OAKDALE, LLC
Doing business as
Oakdale Express Care
Practice address
1884 Highway 165 S
Oakdale, LA 71463-3500
Phone
(318) 335-3501
NPI assigned
Feb 21, 2017
Last updated
Jul 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Authorized official

Name
Suzette Fatula
Title
Cfo
Phone
(318) 215-3223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1884 Highway 165 S
Oakdale, LA 71463-3500

Mailing address

130 Hospital Dr
Oakdale, LA 71463-3035
Phone (318) 215-3431

Other names 1

  • Oakdale Express Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180306000614 LA Part A Provider - Rural Health Clinic 1355623943 Practice locations: Oakdale, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730628975. Details of each certification follow.

Rural health clinic certification: CCN 198509

Legal name
CLHG-OAKDALE LLC
Doing business as
OAKDALE EXPRESS CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 22, 2019
Last certification
Jan 22, 2022
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Aug 5, 2016 in LA
Enrollment address
1884 Highway 165 S
Oakdale, LA 71463-3500
Related CCNs
190106

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
CLHG-Oakdale LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Donald Cameron Individual 5% Or Greater Direct Ownership Interest Sep 1, 2017 27%
Corporate OfficerBoard Member Sep 1, 2017
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Sep 1, 2017 65%
Corporate OfficerBoard Member Sep 1, 2017
Allegiance Health Management Inc Organization, Bossier City, LA Corporation Operational/Managerial Control Sep 1, 2017
Kevin Ardoin Individual Corporate Officer May 26, 2023
Operational/Managerial ControlCeo May 26, 2023
Scott Markstrom Individual 5% Or Greater Direct Ownership Interest Sep 1, 2017 8%
Corporate OfficerBoard Member Sep 1, 2017
Cameron Investments LLC Organization, Shreveport, LA LLC 5% Or Greater Indirect Ownership Interest Sep 1, 2017 8%

Facilities with the same owner 53

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

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1730628975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 HOSPITAL DR",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "714633035",
            "telephone_number": "318-215-3431",
            "fax_number": "318-215-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1884 HIGHWAY 165 S",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "714633500",
            "telephone_number": "318-335-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-OAKDALE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-21",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "FATULA",
        "authorized_official_first_name": "SUZETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "318-215-3223"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oakdale Express Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakdale, LA

Sources for this page

Verify at the official NPI Registry.