NPIMap

Organization Active NPI

CDF Healthcare of la, LLC

Doing business as Richmond Group Home

  • Intellectual Disabilities Intermediate Care Facility
  • Tallulah, LA
National Provider Identifier
1790901205
Registry record updated Jun 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
976 Issued in LA
Legal business name
CDF HEALTHCARE OF LA, LLC
Doing business as
Richmond Group Home
Practice address
100 Caroline St
Tallulah, LA 71282-5508
Phone
(318) 574-5102
Fax
(318) 878-8671
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2010

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

Authorized official

Name
Mr. Joe Debolt
Title
Administrator
Phone
(318) 878-5106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 976 LA Primary

Addresses

Primary practice location

100 Caroline St
Tallulah, LA 71282-5508

Mailing address

PO Box 607
Delhi, LA 71232-0607
Phone (318) 878-5106

Other identifiers 1

IdentifierTypeStateIssuer
1719820MedicaidLA

Other names 1

  • Richmond Group Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790901205. Details of each certification follow.

  • CCN 19G447 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G447

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Richmond Group Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 21, 1992
Last certification
Sep 16, 2025
Beds
8
Ownership / control type
Private (non-profit)
Most recent change of ownership
May 1, 2006
Facility address
100 Caroline Street
Tallulah, LA 71282

National Provider Directory

National Provider Directory
Tax ID family
CDF Healthcare of la LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

100 Caroline St
Tallulah, LA 71282
Phone (318) 574-5102

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276041600000",
    "number": "1790901205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "DELHI",
            "state": "LA",
            "postal_code": "712320607",
            "telephone_number": "318-878-5106",
            "fax_number": "318-878-8671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CAROLINE ST",
            "city": "TALLULAH",
            "state": "LA",
            "postal_code": "712825508",
            "telephone_number": "318-574-5102",
            "fax_number": "318-878-8671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CDF HEALTHCARE OF LA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2010-06-09",
        "status": "A",
        "authorized_official_last_name": "DEBOLT",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-878-5106",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1719820",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richmond Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallulah, LA

Sources for this page

Verify at the official NPI Registry.