Organization
MAINSTAY LIFE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG DOUGLASS MPM (CHIEF PROGRAM OFFICER)
(412) 344-3640
Entity
Organization
Contact information
Practice address
200 ROESSLER RD, PITTSBURGH, PA 15220-1037
(412) 344-3640
(412) 344-5486
Mailing address
200 ROESSLER RD, PITTSBURGH, PA 15220-1037
(412) 344-3640
(412) 344-5486
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000916
—
PA
Enumeration date
01/05/2022
Last updated
01/05/2022
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