MIND REHABILITATION AND RESOURCE CENTER (NPI# 1912364068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912364068 |
| Entity Type | Organization |
| Organization Name | MIND REHABILITATION AND RESOURCE CENTER |
| Practice Address |
1513 Line Ave Suite 135 Shreveport LA 71101-4621 |
| Practice Telephone | 3188281455 |
| Mailing Telephone | 3188281455 |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-01-20 |
| Authorized Official Name | MR. KEN CHINWEZE (OWNER) |
| Authorized Official Telephone | 3188281455 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 101YM0800X | LA | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 2154869 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952767618 | Mind Rehabilitation and Resource Center | Community/Behavioral Health | 1513 Line Ave, Suite 135, Shreveport, LA 71101-4621 | 2016-01-12 |
| Street Address |
1513 LINE AVE SUITE 135 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101-4621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851688105 | Mind Rehabilitation and Resource Center, Inc | Community/Behavioral Health | 1513 Line Ave, Suite 338, Shreveport, LA 71101-4621 | 2011-07-07 |
| 1245839026 | Theresa Jordan | Case Manager/Care Coordinator | 1513 Line Ave, Suite 225, Shreveport, LA 71109 | 2020-10-22 |
| 1255803029 | Tamika Rhinehart | Case Manager/Care Coordinator | 1513 Line Ave, Suite 225, Shreveport, LA 71101 | 2018-12-18 |
| 1790255859 | Christopher Thompson | Case Manager/Care Coordinator | 1513 Line Ave, 222, Shreveport, LA 71101 | 2018-12-03 |
| 1477070324 | J & J Impact Counseling, LLC | Community/Behavioral Health | 1513 Line Ave, Ste 222, Shreveport, LA 71101 | 2017-08-22 |
| 1851838155 | Laura Lynn Holland | Assisted Living Facility | 1513 Line Ave, Ste 250, Shreveport, LA 71101-4621 | 2017-01-24 |
| 1487190161 | Tiwana Thomas | Counselor | 1513 Line Ave, Suite 230, Shreveport, LA 71101-4621 | 2017-01-18 |
| 1174069652 | Fatonia Beaudion | Counselor | 1513 Line Ave, Suite 230, Shreveport, LA 71101-4621 | 2017-01-09 |
| 1811431869 | Mishuna Macdonald | Counselor | 1513 Line Ave, Suite 315, Shreveport, LA 71101-4621 | 2016-12-10 |
| 1881137966 | Shawnee Johnson | Counselor | 1513 Line Ave, 315, Shreveport, LA 71101-4621 | 2016-11-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255988630 | Renee Jewitt | Case Manager/Care Coordinator | 1513 Line Avenue, Suite 225, Shreveport, LA 71101 | 2019-08-21 |
| 1942770094 | Bessie Larry | Case Manager/Care Coordinator | 1513 Line Av, 222, Shreveport, LA 71101 | 2018-12-03 |
| 1750875944 | Jarvis Decarleonne Larry | Community Health Worker | 1513 Line Ave # 222, Shreveport, LA 71101 | 2018-06-20 |
| 1871083485 | Kimberly B. Mcclelland, Lcsw | Counselor | 820 Jordan St. Ste 510w, Shreveport, LA 71101 | 2018-05-18 |
| 1982106456 | Hudson Amc LLC | Internal Medicine | 1800 Irving Place, Shreveport, LA 71101 | 2018-03-01 |
| 1528572955 | Spencer Ron Floyd | Counselor | 1717 Marshall Street, Shreveport, LA 71101 | 2017-11-21 |
| 1578088076 | Brittany Morris | Case Manager/Care Coordinator | 1835 Spring Street Annex Building, Shreveport, LA 71101 | 2017-08-07 |
| 1275058794 | Diane Williams | Case Manager/Care Coordinator | 217 Jones St Apt 510, Shreveport, LA 71101 | 2017-08-04 |
| 1386195972 | Jakeya Woodbury | Counselor | 453 Stoner Ave, Shreveport, LA 71101 | 2016-10-18 |
| 1922459643 | Arlene Huling | Counselor | 449 Egan Street, Shreveport, LA 71101 | 2016-06-23 |
| Find all providers in zip 71101 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558926113 | Renew Therapeutic Services, LLC | Community/Behavioral Health | 2924 Knight St Ste 424, Shreveport, LA 71105-2413 | 2019-05-08 |
| 1053818641 | Agape Love Counseling Service LLC | Community/Behavioral Health | 1513 Line Ave Ste 240, Shreveport, LA 71101-4621 | 2018-04-10 |
| 1851891865 | Magnolia Mental Health LLC | Community/Behavioral Health | 7629 Pines Rd, Shreveport, LA 71129-3905 | 2018-02-15 |
| 1891202776 | Allcare of Louisiana, Inc. | Community/Behavioral Health | 4615 Monkhouse Dr Ste 116, Shreveport, LA 71109-6123 | 2018-01-02 |
| 1467979708 | Finding A Better Me | Community/Behavioral Health | 2924 Knight St Ste 420, Shreveport, LA 71105-2413 | 2017-08-28 |
| 1518495779 | Bridges To Recovery, LLC | Community/Behavioral Health | 7607 Fern Ave Ste 902-903, Shreveport, LA 71105-5739 | 2017-05-31 |
| 1790210805 | Acenter for Hope and Change | Community/Behavioral Health | 6811 Sagewood Dr, Shreveport, LA 71129-9423 | 2017-04-26 |
| 1497289979 | Serenity Behavioral Health Service LLC | Community/Behavioral Health | 2000 Creswell Ave, Shreveport, LA 71104-2202 | 2017-04-12 |
| 1699212696 | Shenells | Community/Behavioral Health | 2120 N Hearne Ave Apt 403, Shreveport, LA 71107-7183 | 2017-01-27 |
| 1669918199 | Street Outreach Solutions,llc | Community/Behavioral Health | 2715 Mackey Pl Ste 119, Shreveport, LA 71118-2527 | 2017-01-08 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71101 |
Please comment or provide details below to improve the information on MIND REHABILITATION AND RESOURCE 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.