EDGEWOOD COMMUNITY HOME – NPI #1336367085
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

Health Care Provider Taxonomy Code for Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

EDGEWOOD COMMUNITY HOME is a community based residential treatment facility located in PINEVILLE, LA. NPPES has assigned the NPI number 1336367085 to EDGEWOOD COMMUNITY HOME on April 20, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “EDGEWOOD COMMUNITY HOME” is a dba name, the actual legal business name for this organization is PINECREST DEVELOPMENTAL CENTER. The primary taxonomy selected by this provider is 320900000X from the Health Care Provider Taxonomy code set, which is classified as Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities.

The NPI profile was previously updated about 6 years ago on Aug 22, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for EDGEWOOD COMMUNITY HOME below.

NPI Profile for
PINECREST DEVELOPMENTAL CENTER

NPI Number
1336367085
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PINECREST DEVELOPMENTAL CENTER
Doing Business As (dba): EDGEWOOD COMMUNITY HOME
Primary location
100 PINECREST DRIVE
PINEVILLE, LA 71361
Phone: (318) 641-2000 Fax: (318) 641-2309
Mailing address
PO BOX 5191
PINEVILLE, LA 71361-5191
Phone: (318) 641-2000 Fax: (318) 641-2309
Organization Subpart
No
Authorized Official
SHERRI EVANS
MR DD REGIONAL ADMINISTRATOR
Phone: (318) 641-2003
Updated
Identifiers

Identifiers for EDGEWOOD COMMUNITY HOME

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDLA1712388
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
320900000X
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Primary)		 LA 955

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.