Organization
ABUNDANT LIVING AT PETERSONS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH PETERSON (CEO CFO)
(412) 231-7866
Entity
Organization
Contact information
Practice address
3884 EAST ST, PITTSBURGH, PA 15214-2029
(412) 231-7866
Mailing address
3884 EAST ST, PITTSBURGH, PA 15214-2029
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
CER-00114910
PA
Other
Enumeration date
11/13/2017
Last updated
11/22/2017
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