Provider Demographics
NPI:1639633597
Name:PAVE CENTER, INC.
Entity Type:Organization
Organization Name:PAVE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-245-4769
Mailing Address - Street 1:277 JONES LOOP
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-5929
Mailing Address - Country:US
Mailing Address - Phone:318-927-2649
Mailing Address - Fax:
Practice Address - Street 1:300 MURREL ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3967
Practice Address - Country:US
Practice Address - Phone:318-245-4769
Practice Address - Fax:318-523-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health