Organization
PINECREST DEVELOPMENTAL CENTER
Active
Other names
Charles Park Community Home
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRI A EVANS (MR DD REGIONAL ADMINISTRATOR)
(318) 641-2003
Entity
Organization
Contact information
Practice address
528 BOB WHITE LN, ALEXANDRIA, LA 71303-2415
(318) 442-4655
(318) 641-2309
Mailing address
PO BOX 5191, PINEVILLE, LA 71361-5191
(318) 442-4655
(318) 641-2309
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
949
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1712337
—
LA
Enumeration date
04/17/2007
Last updated
08/22/2020
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