Provider Demographics
NPI:1740371962
Name:PLEA
Entity type:Organization
Organization Name:PLEA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-243-3464
Mailing Address - Street 1:733 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2939
Mailing Address - Country:US
Mailing Address - Phone:412-243-3464
Mailing Address - Fax:412-243-5649
Practice Address - Street 1:733 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2939
Practice Address - Country:US
Practice Address - Phone:412-243-3464
Practice Address - Fax:412-243-5649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA452840101YM0800X
PA01416286251S00000X
261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA452840Medicaid
PA100775147/0001Medicaid
PA100775147/0002Medicaid