NPIMap

Organization Active NPI

Pinecrest Developmental Center

Doing business as Mar Bud Trace Community Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Pineville, LA
National Provider Identifier
1679756324
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
1612 Issued in LA
Legal business name
PINECREST DEVELOPMENTAL CENTER
Doing business as
Mar Bud Trace Community Home
Practice address
5602 Mar Bud Trace
Pineville, LA 71361
Phone
(318) 441-9905
Fax
(318) 441-9905
NPI assigned
Dec 17, 2007
Last updated
Dec 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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

Authorized official

Name
Ms. 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 1612 LA Primary

Addresses

Primary practice location

5602 Mar Bud Trace
Pineville, LA 71361

Mailing address

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

Other names 1

  • Mar Bud Trace 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": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197849600000",
    "number": "1679756324",
    "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": "5602 MAR BUD TRACE",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "71361",
            "telephone_number": "318-441-9905",
            "fax_number": "318-441-9905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINECREST DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "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": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "LA",
            "license": "1612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mar Bud Trace Community Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pineville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.