Organization
COLUMBIA DEVELOPMENTAL CENTER
Active
Other names
Pineburr Community Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL ANTHONY HARRELL (REGIONAL ASSOCIATE ADMINISTRATOR)
(318) 649-6097
Entity
Organization
Contact information
Practice address
103 PINEBURR DR, COLUMBIA, LA 71418-4766
(318) 649-6097
(318) 649-2868
Mailing address
132 HIGHWAY 850, COLUMBIA, LA 71418-1559
(318) 649-6097
(318) 649-2868
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
655
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1712248
—
LA
Enumeration date
04/24/2007
Last updated
08/22/2020
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