Provider Demographics
NPI:1043399124
Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Entity Type:Organization
Organization Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Other - Org Name:SOUTHWOOD HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:2575 BOYCE PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-3925
Mailing Address - Country:US
Mailing Address - Phone:412-257-2290
Mailing Address - Fax:412-257-7689
Practice Address - Street 1:311 STATION ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1843
Practice Address - Country:US
Practice Address - Phone:412-257-2290
Practice Address - Fax:412-257-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA402890323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130118001Medicaid
PA1007787100017Medicaid
PA0026OtherBLUE CROSS RTF
PA1007787100017OtherCCBHO SMB RTF
PA040679A106581OtherVBH PA SMB RTF
PA4290243OtherAETNA SMB RTF