Organization
PINECREST DEVELOPMENTAL CENTER
Active
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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