NPIMap

Organization Active NPI

Mind Rehabilitation and Resource Center

  • Community/Behavioral Health Agency
  • Shreveport, LA
National Provider Identifier
1952767618
Registry record updated Jan 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MIND REHABILITATION AND RESOURCE CENTER
Practice address
1513 Line Ave
Suite 135
Shreveport, LA 71101-4621
Phone
(318) 828-1455
Fax
(318) 828-1626
NPI assigned
Jan 12, 2016
Last updated
Jan 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2016

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

Authorized official

Name
Mr. Ken Chinweze, CEO
Title
Owner
Phone
(318) 828-1455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1513 Line Ave
Suite 135
Shreveport, LA 71101-4621

Mailing address

1513 Line Ave
Suite 135
Shreveport, LA 71101-4621
Phone (318) 828-1455

Other identifiers 1

IdentifierTypeStateIssuer
2154869MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Mind Rehabilitation Resource Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452556800000",
    "number": "1952767618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1513 LINE AVE",
            "address_2": "SUITE 135",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014621",
            "telephone_number": "318-828-1455",
            "fax_number": "318-828-1626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 LINE AVE",
            "address_2": "SUITE 135",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014621",
            "telephone_number": "318-828-1455",
            "fax_number": "318-828-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND REHABILITATION AND RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-12",
        "last_updated": "2016-01-12",
        "status": "A",
        "authorized_official_last_name": "CHINWEZE",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-828-1455",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2154869",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.