Provider Demographics
NPI:1760567655
Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Entity Type:Organization
Organization Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Other - Org Name:FAMILY BASED SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT 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:412-257-2290
Mailing Address - Fax:412-257-7689
Practice Address - Street 1:443 CHESS ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1955
Practice Address - Country:US
Practice Address - Phone:412-206-0176
Practice Address - Fax:412-206-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA424130251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007787100026Medicaid
PA040679A324171OtherVBH PA FAMILY BASED