Provider Demographics
NPI:1619299377
Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Entity Type:Organization
Organization Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND SECRETARY
Authorized Official - Prefix:
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:412-257-4990
Mailing Address - Fax:412-257-7689
Practice Address - Street 1:120 OLD CONCORD RD
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:PA
Practice Address - Zip Code:15329-1422
Practice Address - Country:US
Practice Address - Phone:724-222-6643
Practice Address - Fax:724-884-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA402860323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130118001OtherWV MEDICAL ASSISTANCE
PA100778710Medicaid
PA0026OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA7792783OtherAETNA BEHAVIORAL HEALTH