NPIMap

Organization Active NPI

Pinecrest Developmental Center

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Alexandria, LA
National Provider Identifier
1457576977
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
1006 Issued in LA
Legal business name
PINECREST DEVELOPMENTAL CENTER
Practice address
3207 Madonna Dr
Alexandria, LA 71301-4816
Phone
(318) 484-9964
Fax
(318) 641-2309
NPI assigned
Apr 17, 2007
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
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 1006 LA Primary

Addresses

Primary practice location

3207 Madonna Dr
Alexandria, LA 71301-4816

Mailing address

PO Box 5191
Pineville, LA 71361-5191
Phone (318) 484-9964

Other identifiers 1

IdentifierTypeStateIssuer
1458953MedicaidLA

Other names 1

  • Madonna Drive Community Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pinecrest Supports and Services 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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457576977",
    "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": "318-484-9964",
            "fax_number": "318-641-2309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 MADONNA DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713014816",
            "telephone_number": "318-484-9964",
            "fax_number": "318-641-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINECREST DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "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"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "LA",
            "license": "1006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1458953",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madonna Drive 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.