PINECREST DEVELOPMENTAL CENTER (NPI# 1598980096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598980096 |
| Entity Type | Organization |
| Organization Name | PINECREST DEVELOPMENTAL CENTER |
| Other Organization Name | CHARLES PARK COMMUNITY HOME |
| Practice Address |
528 Bob White Ln Alexandria LA 71303-2415 |
| Mailing Address |
Po Box 5191 Pineville LA 71361-5191 |
| Practice Telephone | 3184424655 |
| Practice Fax Number | 3186412309 |
| Mailing Telephone | 3184424655 |
| Mailing Fax Number | 3186412309 |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SHERRI A EVANS (MR DD REGIONAL ADMINISTRATOR) |
| Authorized Official Telephone | 3186412003 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 949 | LA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1712337 | 05 |
| Other Name | Type Code |
|---|---|
| Charles Park Community Home | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215172549 | Pinecrest Developmental Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 107 Angelina Drive, Leesville, LA 71446 | 2008-12-16 |
| 1679756324 | Pinecrest Developmental Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5602 Mar Bud Trace, Pineville, LA 71361 | 2007-12-17 |
| 1306062328 | Pinecrest Developmental Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 511 Kimball Ave, Alexandria, LA 71301-5005 | 2007-04-18 |
| 1457576977 | Pinecrest Developmental Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3207 Madonna Dr, Alexandria, LA 71301-4816 | 2007-04-17 |
| 1114143674 | Pinecrest Developmental Center | Day Training, Developmentally Disabled Services | 2969 Highway 28 E, Pineville, LA 71360-5716 | 2007-04-17 |
| 1881974749 | Pinecrest Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2006 Gus Kaplan Dr, Alexandria, LA 71301-3376 | 2011-08-24 |
| 1952614190 | Pinecrest Developmental Center | Clinic/Center | 2006 Gus Kaplan Dr, Alexandria, LA 71301-3376 | 2010-07-16 |
| 1174852875 | Pinecrest Developmental Center | Clinic/Center | 100 Pinecrest Dr, Attn: Paxton Oliver, Pineville, LA 71360-4276 | 2009-12-09 |
| 1316198575 | Pinecrest Developmental Center | Early Intervention Provider Agency | 100 Pinecrest Dr, Pineville, LA 71360-4276 | 2008-10-07 |
| 1336367085 | Pinecrest Developmental Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 100 Pinecrest Drive, Pineville, LA 71361 | 2007-04-20 |
| Street Address |
528 BOB WHITE LN |
| City | ALEXANDRIA |
| State | LA |
| Zip Code | 71303-2415 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609177757 | Peach Community Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 528 Bob White Ln, Alexandria, LA 71303-2415 | 2010-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346877370 | Victoria Bowie | Peer Specialist | 1405 Peterman Drive Suite A, Alexandria, LA 71303 | 2020-03-27 |
| 1396375051 | Christin Authement | Social Worker | 8326 Kelwood Avenue, Alexandria, LA 71303 | 2020-01-22 |
| 1164904520 | Carissa A Sorenson | Pharmacist | 4448 Jackson St, Alexandria, LA 71303 | 2018-09-02 |
| 1144731027 | Bradly Herman | Counselor | 1450 Peterman Drive, Alexandria, LA 71303 | 2017-10-18 |
| 1669991915 | Rashika Holmes | Counselor | 1538 Chase Dr, Alexandria, LA 71303 | 2017-09-18 |
| 1215466594 | Terraniecya Shepherd | Case Manager/Care Coordinator | 700 Veterans Dr. Apt. 608, Alexandria, LA 71303 | 2017-06-08 |
| 1427587864 | Jason Micheal Lachica | Counselor | 3921 Indpendence Drive Ste 104, Alexandria, LA 71303 | 2017-06-08 |
| 1669929188 | Ryan Knoll | Chiropractor | 5419 Jackson St. Ext. Suite B, Alexandria, LA 71303 | 2016-09-01 |
| 1023464393 | Heart of Hospice, LLC | Hospice Care, Community Based | 1001 Bayou Pl, Alexandria, LA 71303 | 2016-05-05 |
| 1770947764 | Jiquiah White | Counselor | 2016 Innis Dr, Alexandria, LA 71303 | 2016-04-06 |
| Find all providers in zip 71303 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275005886 | Transformational Services, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8401 Leaf Rd, Alexandria, VA 22309-1707 | 2018-12-20 |
| 1952880015 | Quintessence Resources, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3318 Memorial St, Alexandria, VA 22306-1545 | 2018-08-09 |
| 1023518289 | Communitty Options, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7979 Alexandria Pike, Alexandria, KY 41001-1157 | 2018-02-14 |
| 1407042567 | Colwell Interest, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3004 Highway 457, Alexandria, LA 71302-9255 | 2007-09-21 |
| 1306062328 | Pinecrest Developmental Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 511 Kimball Ave, Alexandria, LA 71301-5005 | 2007-04-18 |
| 1457576977 | Pinecrest Developmental Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3207 Madonna Dr, Alexandria, LA 71301-4816 | 2007-04-17 |
| 1841414489 | St. Genevive Health Care Services, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3848 Independence Dr, Suite A, Alexandria, LA 71303-3533 | 2007-04-13 |
| 1447474135 | St. Genevive Health Care Services, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3032 Jackson St, Alexandria, LA 71301-4743 | 2007-04-12 |
| 1386727329 | Icon Community Services, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1240 N Pitt St, Suite Ll, Alexandria, VA 22314-5600 | 2006-10-23 |
| 1316272628 | Salvation Academy | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4810 Beauregard St, Suite G1-4, Alexandria, VA 22312-1709 | 2009-10-05 |
| Find all providers in ALEXANDRIA | ||||
| City | ALEXANDRIA |
| Zip Code | 71303 |
Please comment or provide details below to improve the information on PINECREST DEVELOPMENTAL CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.