Healthcare Provider Details

I. General information

NPI: 1346515699
Provider Name (Legal Business Name): CENTER POINT, INC PINES TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 GREENWOOD RD
SHREVEPORT LA
71119-8413
US

IV. Provider business mailing address

6240 GREENWOOD RD
SHREVEPORT LA
71119-8413
US

V. Phone/Fax

Practice location:
  • Phone: 318-632-2010
  • Fax: 318-632-2055
Mailing address:
  • Phone: 318-632-2010
  • Fax: 318-632-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number475
License Number StateLA

VIII. Authorized Official

Name: MRS. THERESE DIANE SCHAFFNER
Title or Position: COUNSELOR II
Credential: LPC-I CI4907
Phone: 318-632-2010