Healthcare Provider Details

I. General information

NPI: 1912186461
Provider Name (Legal Business Name): COMMUNITY EMPOWERMENT ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 KELLY ST
PITTSBURGH PA
15208-1843
US

IV. Provider business mailing address

7120 KELLY ST
PITTSBURGH PA
15208-1843
US

V. Phone/Fax

Practice location:
  • Phone: 412-371-3689
  • Fax: 412-371-0792
Mailing address:
  • Phone: 412-371-3689
  • Fax: 412-371-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number443930
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number101043032
License Number StatePA

VIII. Authorized Official

Name: MR. RASHAD BYRDSONG
Title or Position: PRESIDENT & CEO
Credential:
Phone: 412-371-3689