# PINECREST DEVELOPMENTAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366564163
- **Authorized official:** MS. MONICA R BRYANT (DIRECTOR OF FISCAL SERVICES)
- **Authorized official phone:** (318) 641-2216

## Contact information

- **Practice address:** 100 PINECREST DRIVE, PINEVILLE, LA 71360
- **Practice address phone:** (318) 641-2000
- **Practice address fax:** (318) 641-2300
- **Mailing address:** PO BOX 5191, PINEVILLE, LA 71361-5191
- **Mailing address phone:** (318) 641-2000
- **Mailing address fax:** (318) 641-2300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 991000271 | LA | Yes |

## Other

- **Enumeration date:** 04/04/2007
- **Last updated:** 11/02/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1712001 | — | LA |