Provider Demographics
NPI:1972662625
Name:BHC NORTHWEST PSYCHIATRIC HOSPITAL LLC
Entity Type:Organization
Organization Name:BHC NORTHWEST PSYCHIATRIC HOSPITAL LLC
Other - Org Name:BROOKE GLEN BEHAVIORAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GABRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-641-6868
Mailing Address - Street 1:7170 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034
Mailing Address - Country:US
Mailing Address - Phone:215-641-5300
Mailing Address - Fax:215-653-7872
Practice Address - Street 1:7170 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034
Practice Address - Country:US
Practice Address - Phone:215-641-5300
Practice Address - Fax:215-653-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1221302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394049Medicare Oscar/Certification
PA072885Medicare ID - Type UnspecifiedMEDICARE B