Provider Demographics
NPI:1518912377
Name:NINE PALMS 1, LLC
Entity type:Organization
Organization Name:NINE PALMS 1, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3726
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:5360 DISCOVERY PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2860
Practice Address - Country:US
Practice Address - Phone:757-253-2536
Practice Address - Fax:757-253-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA236402OtherMAMSI
VA299072OtherMAMSI HEALTH PLANS
VA4971264Medicaid
VA5965078OtherAETNA US HEALTH CARE
VA19649OtherSENTARA HEALTH PLAN
VA004971248OtherVA PRIEIMER HEALTH PLAN
VA226349OtherMAMSI HEALTH PLANS
VA442171OtherBCBS VA ANTHEM
VA004971159OtherVA PRIEIMER HEALTH PLAN
VA442235OtherBCBS VA ANTHEM
VI442173OtherBCBS VA ANTHEM
VA442175OtherBCBS VA ANTHEM
VA1851340OtherCIGNA
VA4971264Medicaid
VA19649OtherSENTARA HEALTH PLAN
VA236402OtherMAMSI
VA4971256Medicaid
VA442235OtherBCBS VA ANTHEM
VA4971256Medicaid
VA236402OtherMAMSI