MEDICARE: LAUREL HIGHLANDS FOUNDATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	436000	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000021980043	OTHER	PA	MPI#
2	1000021980044	OTHER	PA	MPI#

General Provider Information

NPI Number	:	1104040302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL HIGHLANDS FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	1000 JACKS RUN RD
Second Line	:
City	:	NORTH VERSAILLES
State	:	PA
Zip	:	15137-2744
Country	:	US
Telephone Number	:	412-825-9141
Fax Number	:	412-825-9456

Provider Business Practice Location Address
First Line	:	1217 MOUNT PLEASANT RD
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-6331
Country	:	US
Telephone Number	:	724-838-8149
Fax Number	:	724-838-8149

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. TIMOTHY W. PEARL
Credential	:
Telephone Number	:	412-825-9141

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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