Provider Demographics
NPI:1740378843
Name:PECAN GROVE TRAINING CENTER
Entity Type:Organization
Organization Name:PECAN GROVE TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-1635
Mailing Address - Street 1:3844 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3533
Mailing Address - Country:US
Mailing Address - Phone:318-445-1635
Mailing Address - Fax:318-473-0490
Practice Address - Street 1:5000 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-5103
Practice Address - Country:US
Practice Address - Phone:318-445-1635
Practice Address - Fax:318-473-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities