Provider Demographics
NPI:1326325341
Name:CPCDS/AMBULATORY DETOX
Entity Type:Organization
Organization Name:CPCDS/AMBULATORY DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N.
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-551-8273
Mailing Address - Street 1:512 MALABAR DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-2526
Mailing Address - Country:US
Mailing Address - Phone:724-327-4277
Mailing Address - Fax:
Practice Address - Street 1:512 MALABAR DR.
Practice Address - Street 2:
Practice Address - City:PITTSBURGH.
Practice Address - State:PA
Practice Address - Zip Code:15239-2526
Practice Address - Country:US
Practice Address - Phone:724-327-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN303756L261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder