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PECAN GROVE COMMUNITY HOME
NPI 1780894477
Intermediate Care Facility, Intellectual Disabilities in Mansfield, LA

Active since May 23, 2007
167 POOLE ROAD, MANSFIELD, LA 71052(318) 872-0206(318) 872-8833 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Pecan Grove Community Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PECAN GROVE COMMUNITY HOME (NPI 1780894477) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Mansfield, Louisiana and active in the NPI registry since May 2007. The organization lists Johnny Drew Terrell, Administrator, as its authorized official.

NPPES Registry Identity

NPI1780894477
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NamePROVINCIAL COMMUNITY HOME INC
Location Address167 POOLE ROADMansfield, LA 71052-5007
Mailing Address167 Poole RoadMansfield, LA 71052-5007 · (318) 872-0206 · Fax (318) 872-8833
Phone(318) 872-0206
Fax(318) 872-8833
Organization SubpartNo
Authorized OfficialJohnny Drew TerrellAdministrator · (318) 872-0206
Enumeration DateMay 23, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1780894477 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
License✔ Licensed in LA · 636
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
167 POOLE ROAD, Mansfield, LA 71052
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Other Names 1

Other NamePecan Grove Community Home

Other Identifiers 1

Medicaid1718971LA

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Provincial Community Home Inc's NPI number?

The NPI number for Provincial Community Home Inc is 1780894477. It was assigned to this organization in the NPPES registry on May 23, 2007. The provider is also known as Pecan Grove Community Home.

Where is Provincial Community Home Inc located?

Provincial Community Home Inc is located at 167 Poole Road, Mansfield, LA 71052. The listed phone number is (318) 872-0206.

What is Provincial Community Home Inc's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

When was this NPI record last updated?

The NPPES record for Provincial Community Home Inc was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.