Provider Demographics
NPI:1720461205
Name:PRESSLEY RIDGE
Entity type:Organization
Organization Name:PRESSLEY RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-872-9400
Mailing Address - Street 1:327 BEALL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3372
Mailing Address - Country:US
Mailing Address - Phone:301-724-8413
Mailing Address - Fax:
Practice Address - Street 1:327 BEALL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3372
Practice Address - Country:US
Practice Address - Phone:301-724-8413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1492251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD643078OtherVALUE OPTIONS (MEDICAID MANAGED CARE)