NORTHWEST SUPPORTS AND SERVICES CENTER (NPI# 1912125311) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912125311 |
| Entity Type | Organization |
| Organization Name | NORTHWEST SUPPORTS AND SERVICES CENTER |
| Other Organization Name | NORTHWEST LOUISIANA DEVELOPMENTAL CENTER |
| Practice Address |
5401 Shed Rd Bossier City LA 71111-5420 |
| Practice Telephone | 3187415230 |
| Practice Fax Number | 3187415303 |
| Mailing Telephone | 3187415230 |
| Mailing Fax Number | 3187415303 |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2009-02-27 |
| Authorized Official Name | DAVID COLVIN (ADMINISTRATOR) |
| Authorized Official Telephone | 3187415230 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | PCA 8774 | LA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1712035 | 05 | |
| LA | 1567230 | 05 | |
| LA | 1156752 | 05 | |
| LA | 1156761 | 05 | |
| LA | 1408182 | 05 |
| Other Name | Type Code |
|---|---|
| Northwest Louisiana Developmental Center | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689715179 | Northwest Supports and Services Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2007-02-09 |
| 1871732628 | Northwest Supports and Services Center | Early Intervention Provider Agency | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2009-02-18 |
| 1730307133 | Northwest Supports and Services Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2007-04-23 |
| 1558589952 | Northwest Supports and Services Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2007-04-23 |
| 1467670869 | Northwest Supports and Services Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2007-04-23 |
| Street Address |
5401 SHED RD |
| City | BOSSIER CITY |
| State | LA |
| Zip Code | 71111-5420 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689715179 | Northwest Supports and Services Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2007-02-09 |
| 1902275043 | Arc of Acadiana, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2015-09-18 |
| 1811366958 | Arc of Acadiana, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2015-09-18 |
| 1134479066 | Arc of Acadiana, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2012-09-18 |
| 1154687978 | Tommy Ray Robinson | Physician Assistant | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2012-04-05 |
| 1235370685 | Michael Mcdougald | Social Worker | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2009-03-16 |
| 1205076098 | Tiney Latson | Registered Nurse | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2009-03-06 |
| 1871732628 | Northwest Supports and Services Center | Early Intervention Provider Agency | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2009-02-18 |
| 1578702643 | Arien Mckenzie Ward | Psychologist | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2009-02-13 |
| 1841439197 | Michelle Jarrell Rock | Physical Therapist | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2009-02-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669007951 | Tamara 'tammy' Larck | Counselor | 1525 Fullilove Drive, Shreveport, LA 71111 | 2020-03-06 |
| 1912538315 | Lagniappe Chiropractic | Chiropractor | 2400 Airline Drive, Bossier City, LA 71111 | 2020-02-04 |
| 1649817420 | Lifecare Medical Transportation, LLC. | Non-emergency Medical Transport (VAN) | 25 Duck Haven Pointe, Bossier City, LA 71111 | 2019-11-29 |
| 1770126344 | Bertresea White Evans | Nurse Practitioner | Coastal Urgernt Care, 5314 Airline Drive, Bossier City, LA 71111 | 2019-10-25 |
| 1861964058 | Erika Davis Reed | Counselor | 1515 Doctors Dr # 16, Bossier City, LA 71111 | 2018-12-28 |
| 1518436898 | Charlotte Mckay | Case Manager/Care Coordinator | 31330 Hwy 22, Ste 101, Bossier City, LA 71111 | 2018-11-16 |
| 1992271464 | Np2u, LLC | Nurse Practitioner | 2008 Airline Drive Suite 300 #194, Bossier City, LA 71111 | 2018-10-22 |
| 1114416542 | Lashaunda Autrey | Counselor | 410 Half Moon Lane, Bossier, LA 71111 | 2018-05-01 |
| 1750887196 | Shenya Williams-pennywell | Counselor | 1007 Gould Drive Bldg 2, Suite 1, Bossier City, LA 71111 | 2018-04-04 |
| 1336647304 | Patrick Vance | Physical Therapist | 5000 Benton Rd Ste 1, Bossier City, LA 71111 | 2018-01-24 |
| Find all providers in zip 71111 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922147222 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3907 Shed Rd, Bossier City, LA 71111-5214 | 2007-02-05 |
| 1902275043 | Arc of Acadiana, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2015-09-18 |
| 1811366958 | Arc of Acadiana, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2015-09-18 |
| 1720454200 | Arc of Acadiana, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Road, Bossier City, LA 71111 | 2015-08-19 |
| 1134479066 | Arc of Acadiana, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2012-09-18 |
| 1730307133 | Northwest Supports and Services Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2007-04-23 |
| 1558589952 | Northwest Supports and Services Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2007-04-23 |
| 1467670869 | Northwest Supports and Services Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5401 Shed Rd, Bossier City, LA 71111-5420 | 2007-04-23 |
| 1104965409 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3907 Shed Rd, Bossier City, LA 71111-5214 | 2007-02-05 |
| 1336288802 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3907 Shed Rd, Bossier City, LA 71111-5214 | 2007-02-05 |
| Find all providers in BOSSIER CITY | ||||
| City | BOSSIER CITY |
| Zip Code | 71111 |
Please comment or provide details below to improve the information on NORTHWEST SUPPORTS AND SERVICES CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.