=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962604462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL OUTREACH RESOURCE AND REFERRAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1860 CENTRE AVE SUITE 106
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219-4369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-471-9806
-----------------------------------------------------
Fax | 412-471-1171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 53033
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219-0033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-471-9806
-----------------------------------------------------
Fax | 412-471-1171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | CLIFFORD FOSTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-471-9806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------