Healthcare Provider Details

I. General information

NPI: 1114594751
Provider Name (Legal Business Name): PRESSLEY RIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 GRANT GDNS
ONA WV
25545-9731
US

IV. Provider business mailing address

5500 CORPORATE DR STE 400
PITTSBURGH PA
15237-5848
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-0944
  • Fax: 304-296-9562
Mailing address:
  • Phone: 412-872-9422
  • Fax: 412-872-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LORA KOST
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 412-872-9422