Organization
PINECREST DEVELOPMENTAL CENTER
Active
Other names
Mar Bud Trace Community Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHERRI A EVANS (MR DD REGIONAL ADMINISTRATOR)
(318) 641-2003
Entity
Organization
Contact information
Practice address
5602 MAR BUD TRACE, PINEVILLE, LA 71361
(318) 441-9905
(318) 441-9905
Mailing address
PO BOX 5191, PINEVILLE, LA 71361-5191
(318) 641-2000
(318) 641-2309
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1612
LA
Other
Enumeration date
12/17/2007
Last updated
12/17/2007
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