Provider Demographics
NPI:1104040302
Name:LAUREL HIGHLANDS FOUNDATION, INC.
Entity Type:Organization
Organization Name:LAUREL HIGHLANDS FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-825-9141
Mailing Address - Street 1:1000 JACKS RUN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-2744
Mailing Address - Country:US
Mailing Address - Phone:412-825-9141
Mailing Address - Fax:412-825-9456
Practice Address - Street 1:1217 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6331
Practice Address - Country:US
Practice Address - Phone:724-838-8149
Practice Address - Fax:724-838-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA436000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021980043OtherMPI#
PA1000021980044OtherMPI#