NPIMap

Organization Active NPI

Pinecrest Developmental Center

Doing business as Kimball Community Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Alexandria, LA
National Provider Identifier
1306062328
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
937 Issued in LA
Legal business name
PINECREST DEVELOPMENTAL CENTER
Doing business as
Kimball Community Home
Practice address
511 Kimball Ave
Alexandria, LA 71301-5005
Phone
(318) 445-8200
Fax
(318) 641-2309
NPI assigned
Apr 18, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sherri A. Evans
Title
Mr DD Regional Administrator
Phone
(318) 641-2003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 937 LA Primary

Addresses

Primary practice location

511 Kimball Ave
Alexandria, LA 71301-5005

Mailing address

PO Box 5191
Pineville, LA 71361-5191
Phone (318) 641-2000

Other identifiers 1

IdentifierTypeStateIssuer
1725013MedicaidLA

Other names 1

  • Kimball Community Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pinecrest Developmental Center19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306062328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5191",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713615191",
            "telephone_number": "318-641-2000",
            "fax_number": "318-641-2309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 KIMBALL AVE",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713015005",
            "telephone_number": "318-445-8200",
            "fax_number": "318-641-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINECREST DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "SHERRI",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MR DD REGIONAL ADMINISTRATOR",
        "authorized_official_telephone_number": "318-641-2003",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "LA",
            "license": "937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1725013",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kimball Community Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alexandria, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.