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Organization Active NPI

Homer Memorial Hospital

Doing business as Claiborne Memorial Medical Center

  • General Acute Care Hospital
  • Homer, LA
National Provider Identifier
1831183748
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
206 Issued in NU
Legal business name
HOMER MEMORIAL HOSPITAL
Doing business as
Claiborne Memorial Medical Center
Practice address
620 East College St
Homer, LA 71040-3202
Phone
(318) 927-2024
Fax
(318) 927-9212
NPI assigned
Sep 7, 2005
Last updated
Feb 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Authorized official

Name
Tina Haynes
Title
Ceo
Phone
(318) 927-2024

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 206 LA
General Acute Care Hospital 282N00000X 206 NU Primary

Addresses

Primary practice location

620 East College St
Homer, LA 71040-3202

Mailing address

620 East College St
Homer, LA 71040-3202
Phone (318) 927-2024

Other identifiers 4

IdentifierTypeStateIssuer
1705802MedicaidLA
1734403MedicaidLA
1799645MedicaidLA
1402541MedicaidLA

Other names 1

  • Claiborne Memorial Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100113000973 LA Part A Provider - Hospital 1456322692 Practice locations: Homer, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831183748. Details of each certification follow.

Hospital certification: CCN 190114

Legal name
HOMER MEMORIAL HOSPITAL
Doing business as
CLAIBORNE MEMORIAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 13, 1967
Last certification
Sep 22, 2022
Beds
47
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
620 E College St
Homer, LA 71040-3202
Main/Primary Hospital Location
Hospital subgroups
Acute care, Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Claiborne Memorial Medical CenterCCN 190114 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Homer Memorial Hosp Beh13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

620 E College St
Homer, LA 71040
Phone (318) 927-2024

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Beverlee Killgore Individual Operational/Managerial ControlBoard Member Sep 10, 2014 11.11%
Betty Sanford Individual W-2 Managing Employee Sep 10, 2014
Anna Lee Jones Individual Corporate DirectorCno Jan 1, 2022
W-2 Managing EmployeeCno Jan 1, 2022
William M Haynes Individual Operational/Managerial ControlBoard Member Sep 10, 2014 11.11%
Sherman E Brown Individual Operational/Managerial ControlBoard Member Sep 10, 2014 11.11%
James Colvin Individual Corporate Director Sep 8, 2009
Mark a Brown Individual Operational/Managerial ControlChairman of the Board (Member) Sep 10, 2014 11.11%
Samuel K Abshire Individual Operational/Managerial ControlBoard Member Sep 10, 2014 11.11%
Amy Legendre Individual W-2 Managing EmployeeCfo Jul 1, 2025
Tina Haynes Individual Corporate OfficerInterim Ceo May 13, 2019
W-2 Managing EmployeeInterim Ceo May 13, 2019
Wade Holloway Individual Operational/Managerial Control Jan 1, 2022
Kevin Gray Individual Operational/Managerial Control Jan 1, 2022

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Homer Medical ClinicHomer, LA, CCN 198507 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 30, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 65

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

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1831183748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 EAST COLLEGE ST",
            "city": "HOMER",
            "state": "LA",
            "postal_code": "710403202",
            "telephone_number": "318-927-2024",
            "fax_number": "318-927-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 EAST COLLEGE ST",
            "city": "HOMER",
            "state": "LA",
            "postal_code": "710403202",
            "telephone_number": "318-927-2024",
            "fax_number": "318-927-9212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMER MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-927-2024"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "LA",
            "license": "206",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": "206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1705802",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1734403",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1799645",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1402541",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Claiborne Memorial Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Claiborne Memorial Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Homer, LA

Sources for this page

Verify at the official NPI Registry.