NPIMap

Organization Active NPI

Red River Behavioral Center LLC

  • Psychiatric Hospital
  • Bossier City, LA
National Provider Identifier
1881638880
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
572 Issued in LA
Legal business name
RED RIVER BEHAVIORAL CENTER LLC
Practice address
2800 Melrose Ave
Bossier City, LA 71111
Phone
(318) 549-2033
Fax
(318) 549-3745
NPI assigned
Jun 16, 2006
Last updated
Mar 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Authorized official

Name
Susan Kottenbrook
Title
Director/ Administrator
Phone
(318) 549-2033

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 572 LA Primary

Addresses

Primary practice location

2800 Melrose Ave
Bossier City, LA 71111

Mailing address

2800 Melrose Ave
Bossier City, LA 71111-5870
Phone (318) 549-2033

Other identifiers 1

IdentifierTypeStateIssuer
1709565MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050816000689 LA Part A Provider - Hospital 8022048461 Practice locations: Bossier City, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881638880. Details of each certification follow.

Hospital certification: CCN 194079

Legal name
RED RIVER BEHAVIORAL CENTER LLC
Doing business as
RED RIVER BEHAVIORAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Oct 7, 2005
Last certification
Feb 15, 2023
Beds
20
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jul 12, 2004 in LA
Enrollment address
2800 Melrose Avenue
Bossier City, LA 71111-5870
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Red River Behavioral Center, LLCCCN 194079 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1043537Red River Behavioral Center LLC2800 Melrose Avenue, Bossier City, LA 71111Certificate of waiverJul 26, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2800 Melrose Ave
Bossier City, LA 71111
Phone (318) 549-2033

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Ronald R Payne Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2014 30%
Susan Kottenbrook Individual W-2 Managing EmployeeAdministrator Jun 15, 2011
Operational/Managerial ControlAdministrator Jun 15, 2011
Rod Baronet Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2014 19%
Operational/Managerial ControlManager Mar 1, 2014
RRP Interests LLC Organization, Frisco, TX For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2014 20%
Quality Care Givers Inc Organization, Alexandria, LA For-profit Operational/Managerial Control Mar 1, 2014
Dawn Moran Individual Operational/Managerial ControlManager Mar 1, 2014
James Shelton Individual 5% Or Greater Indirect Ownership Interest Sep 25, 2023 30%
Jdec Health, LLC Organization, Pineville, LA LLC 5% Or Greater Direct Ownership Interest Sep 25, 2023 30%
Veritas Health Services LLC Organization, Alexandria, LA For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2014 40%
Keyco Holdings, LLC Organization, Plano, TX LLC 5% Or Greater Direct Ownership Interest Sep 25, 2023 10%

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584403200000",
    "number": "1881638880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MELROSE AVE",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711115870",
            "telephone_number": "318-549-2033",
            "fax_number": "318-549-3745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 MELROSE AVE",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "71111",
            "telephone_number": "318-549-2033",
            "fax_number": "318-549-3745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED RIVER BEHAVIORAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "KOTTENBROOK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR/ ADMINISTRATOR",
        "authorized_official_telephone_number": "318-549-2033"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "LA",
            "license": "572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1709565",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.