Organization
PINECREST DEVELOPMENTAL CENTER
Active
Other names
Central LA Resource Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAXTON ENIS OLIVER II M.S. (MR/DD REGIONAL ASSOCIATE ADMINISTER)
(318) 487-5395
Entity
Organization
Contact information
Practice address
2006 GUS KAPLAN DR, ALEXANDRIA, LA 71301-3376
(318) 487-5395
(318) 487-5463
Mailing address
2006 GUS KAPLAN DR, ALEXANDRIA, LA 71301-3376
(318) 487-5395
(318) 487-5463
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
LA
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
LA
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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