Healthcare Provider Details

I. General information

NPI: 1245458991
Provider Name (Legal Business Name): PINECREST DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2969 HIGHWAY 28 E
PINEVILLE LA
71360-5716
US

IV. Provider business mailing address

PO BOX 5191
PINEVILLE LA
71361-5191
US

V. Phone/Fax

Practice location:
  • Phone: 318-641-2000
  • Fax: 318-641-2309
Mailing address:
  • Phone: 318-641-2000
  • Fax: 318-641-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberADC9419
License Number StateLA

VIII. Authorized Official

Name: SHERRI A EVANS
Title or Position: MR DD REGIONAL ADMINISTRATOR
Credential:
Phone: 318-641-2003