Sanctuary Louisiana LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

SANCTUARY LOUISIANA LLC

Doing business as

Sanctuary of Louisiana Clinic

Practice address

21089 South Frontage Road
Lacassine, LA 70650-9998

Phone

(337) 936-9197

Fax

(337) 588-4179

NPI assigned

Aug 13, 2020

Last updated

Aug 29, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

SANCTUARY LOUISIANA LLCAs reported in NPPES

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

Authorized official

Name

Kelvin SmithNPI 1841853306

Title

Administrator

Phone

(337) 936-9197

Specialties & licenses 7

Addresses

Other names 1

• SANCTUARY OF LOUISIANA CLINIC Doing business as

Part of

Sanctuary Louisiana LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Sanctuary Louisiana, LLC

  • Substance Abuse Rehabilitation Facility
  • Lacassine, LA
  • NPI 1336688878
  NPPES parent name

Practitioners 1

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.

• Kelvin Martin Smith, CIT

  • Addiction (Substance Use Disorder) Counselor
  • Lacassine, LA
  • NPI 1841853306
  Authorized official Same address or phone

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1982215851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1967",
            "city": "IOWA",
            "state": "LA",
            "postal_code": "706471967",
            "telephone_number": "337-936-9197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21089 SOUTH FRONTAGE ROAD",
            "city": "LACASSINE",
            "state": "LA",
            "postal_code": "706509998",
            "telephone_number": "337-936-9197",
            "fax_number": "337-588-4179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANCTUARY LOUISIANA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANCTUARY  LOUISIANA LLC",
        "enumeration_date": "2020-08-13",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KELVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "337-936-9197"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SANCTUARY OF LOUISIANA CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SANCTUARY OF LOUISIANA CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gina Marie Caldarera, LAC
• Genesis Life LLC
• Michelle Lejeune Langley
• James Fitzgerald Mills, CIT
• Sanctuary Louisiana, LLC
• Kelvin Martin Smith, CIT
• Sabrina Kay Wells

• Substance Use Disorder Rehabilitation Clinic/Center in Lacassine, LA
• Providers in Lacassine, LA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.