Provider Demographics
NPI:1871675504
Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Entity Type:Organization
Organization Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Other - Org Name:PRO SITE RTFS
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 1:130 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:724-222-7486
Practice Address - Fax:724-222-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA402870323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040679OtherVALUE PROVIDER #
WV0130118001Medicaid
PA1007787100011Medicaid
PA0026OtherBLUE CROSS RTF
PA1007787100011OtherCCBHO PRO RTFS
PA040679A324172OtherVBH PA PRO RTFS
PA4290243OtherAETNA PRO RTFS