NPIMap

Organization Active NPI

Jefferson Group Home

  • Intellectual Disabilities Intermediate Care Facility
  • Alexandria, LA
National Provider Identifier
1821130717
Registry record updated Nov 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
946 Issued in LA
Legal business name
JEFFERSON GROUP HOME
Practice address
1109 Presidents Drive
Alexandria, LA 71303
Phone
(318) 473-2505
Fax
(318) 473-2506
NPI assigned
Feb 14, 2007
Organization subpart
Yes
Parent organization
WESTSIDE HABILITATION CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2009

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

Authorized official

Name
Ms. Christina Bonnette Bolton
Title
Administrator
Phone
(318) 445-1551

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 946 LA Primary

Addresses

Primary practice location

1109 Presidents Drive
Alexandria, LA 71303

Mailing address

PO Box 7917
Alexandria, LA 71306-0917
Phone (318) 445-1551

Other identifiers 2

IdentifierTypeStateIssuer
1507211OtherLAUNISYS
19G574MedicaidLA

Medicare participation

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

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G574

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
Jefferson Group Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 10, 2006
Last certification
Feb 24, 2025
Beds
14
Ownership / control type
Private (non-profit)
Facility address
1109 Presidents Drive
Alexandria, LA 71303

National Provider Directory

National Provider Directory
Tax ID family
Taft Community Home28 organizations share this tax ID, including this one
Part of
Taft Community Home

Other organizations with this tax ID 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257552000000",
    "number": "1821130717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7917",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713060917",
            "telephone_number": "318-445-1551",
            "fax_number": "318-445-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 PRESIDENTS DRIVE",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "71303",
            "telephone_number": "318-473-2505",
            "fax_number": "318-473-2506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON GROUP HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTSIDE HABILITATION CENTER, INC.",
        "enumeration_date": "2007-02-14",
        "last_updated": "2009-11-07",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "BONNETTE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-445-1551",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISYS",
            "identifier": "1507211",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19G574",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, LA

Sources for this page

Verify at the official NPI Registry.