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General NPI Number Information
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NPI Number | 1639633597
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Entity Type | Organization
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Legal Business Name | PAVE CENTER, INC.
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 300 MURREL ST
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City | HOMER
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State | LA
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Zip | 71040-3967
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Country | US
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Telephone | 318-245-4769
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Fax | 318-523-0235
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Provider Business Mailing Address
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Address Line | 277 JONES LOOP
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City | HOMER
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State | LA
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Zip | 71040-5929
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Country | US
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Telephone | 318-927-2649
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHARON WARREN
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Credential |
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Telephone | 318-245-4769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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