Pecan Haven Addiction Recovery Center, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

220382709 Issued in LA

Legal business name

PECAN HAVEN ADDICTION RECOVERY CENTER, LLC

Practice address

2321 Hwy 80 East
Monroe, LA 71203

Phone

(318) 600-3333

Fax

(318) 600-3334

NPI assigned

May 18, 2015

Organization subpart

No

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

Authorized official

Name

Amanda Peeler Fontenot, CPPM

Title

Business Manager

Phone

(318) 600-3333

Specialties & licenses 1

Addresses

Other names 1

• Pecan Haven Adolescent Addiction Center Former legal business name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1366820706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 HWY 80 EAST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71203",
            "telephone_number": "318-600-3333",
            "fax_number": "318-600-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 HWY 80 EAST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71203",
            "telephone_number": "318-600-3333",
            "fax_number": "318-600-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN HAVEN ADDICTION RECOVERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-18",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "FONTENOT",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "PEELER",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "318-600-3333",
        "authorized_official_credential": "CPPM"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "LA",
            "license": "220382709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pecan Haven Adolescent Addiction Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Monroe, LA
• Providers in Monroe, LA by specialty
• Substance Abuse Rehabilitation Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.