Provider Demographics
NPI:1316198575
Name:PINECREST DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:PINECREST DEVELOPMENTAL CENTER
Other - Org Name:PINECREST SUPPORTS AND SERVICES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-641-2006
Mailing Address - Street 1:PO BOX 5191
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71361-5191
Mailing Address - Country:US
Mailing Address - Phone:318-641-2115
Mailing Address - Fax:318-641-2309
Practice Address - Street 1:100 PINECREST DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4276
Practice Address - Country:US
Practice Address - Phone:318-641-2115
Practice Address - Fax:318-641-2309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINECREST DEVELOPMENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency