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General NPI Number Information
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NPI Number | 1952614190
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Entity Type | Organization
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Legal Business Name | PINECREST DEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 2006 GUS KAPLAN DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3376
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Country | US
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Telephone | 318-487-5395
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Fax | 318-487-5463
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Provider Business Mailing Address
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Address Line | 2006 GUS KAPLAN DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3376
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Country | US
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Telephone | 318-487-5395
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Fax | 318-487-5463
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Authorized Official
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Title or Position | MR/DD REGIONAL ASSOC. ADMINISTRATOR
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Name | MR. PAXTON E. OLIVER II
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Credential | M. S.
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Telephone | 318-487-5395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | LA
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