NPIMap

Organization Active NPI

Allegiance Home Health of Southwest Louisiana, LLC

  • Home Health Agency
  • Deridder, LA
National Provider Identifier
1740844620
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ALLEGIANCE HOME HEALTH OF SOUTHWEST LOUISIANA, LLC
Practice address
108 W 3Rd St
Deridder, LA 70634-4024
Phone
(337) 462-3747
Fax
(337) 462-3790
NPI assigned
Apr 26, 2019
Last updated
Jan 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Authorized official

Name
Rhonda Mayo
Title
Administrator
Phone
(337) 462-3747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

108 W 3Rd St
Deridder, LA 70634-4024

Mailing address

108 W 3Rd St
Deridder, LA 70634-4024
Phone (337) 462-3747

Other identifiers 2

IdentifierTypeStateIssuer
2623141MedicaidLA
31245OtherLABCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190628001988 LA Part A Provider - Home Health Agency 1052645702 Practice locations: Deridder, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740844620. Details of each certification follow.

Home health agency certification: CCN 197520

Legal name
ALLEGIANCE HOME HEALTH OF SOUTHWEST LOUISIANA, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 3, 1993
Last certification
May 27, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
108 W 3Rd St
Deridder, LA 70634-4024

Care Compare: Home health agency

Medicare Care Compare
Listed as
Allegiance Home Health of Southwest Louisiana, LLCCCN 197520 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Mar 3, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

128 W 4th St
Dequincy, LA 70633
Phone (337) 786-1638

108 W 3rd St
Deridder, LA 70634
Phone (337) 238-5180

Ownership & related parties

All disclosed owners & managing parties 7

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 Corporate Officer Apr 1, 2019
Corporate DirectorBoard Member Apr 1, 2019
Operational/Managerial ControlBoard Member Apr 1, 2019
Rock Bordelon Individual 5% Or Greater Indirect Ownership Interest Feb 7, 2022
Corporate DirectorBoard Member Apr 1, 2019
Operational/Managerial ControlOwner, Board Member Apr 1, 2019
Allegiance Healthcare of Louisiana, LLC Organization, Bossier City, LA LLC 5% Or Greater Direct Ownership Interest Jan 31, 2022 95%
Ginger Ezell Individual Corporate OfficerDirector of Revenue Cycle Sep 13, 2021
Joseph Monsour Individual Corporate OfficerChief Executive Officer May 28, 2019
Operational/Managerial ControlChief Executive Officer May 28, 2019
Khaled Ghorab Individual 5% Or Greater Direct Ownership Interest Feb 7, 2022 5%
Corporate Director Apr 1, 2019
Operational/Managerial Control Apr 1, 2019
Allegiance Home Health LLC Organization, Bossier City, LA LLC Operational/Managerial Control Nov 12, 2020 100%

Facilities with the same owner 12

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

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2019 Change of OwnershipThis provider was the buyer Dequincy Home Health IncCCN 197520, LA, NPI 1093708349

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1556236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1740844620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 W 3RD ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344024",
            "telephone_number": "337-462-3747",
            "fax_number": "337-462-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W 3RD ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344024",
            "telephone_number": "337-462-3747",
            "fax_number": "337-462-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLEGIANCE HOME HEALTH OF SOUTHWEST LOUISIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-26",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A",
        "authorized_official_last_name": "MAYO",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "337-462-3747"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2623141",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "31245",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deridder, LA

Sources for this page

Verify at the official NPI Registry.