Healthcare Provider Details

I. General information

NPI: 1215003447
Provider Name (Legal Business Name): PERSAD CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BUTLER ST SUITE 100
PITTSBURGH PA
15201-2656
US

IV. Provider business mailing address

5301 BUTLER ST SUITE 100
PITTSBURGH PA
15201-2656
US

V. Phone/Fax

Practice location:
  • Phone: 412-441-9786
  • Fax: 412-408-3720
Mailing address:
  • Phone: 412-441-9786
  • Fax: 412-408-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number707239
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number459220
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. DEREK BARNES
Title or Position: BILLING MANAGER
Credential:
Phone: 412-441-9786