Provider Demographics
NPI:1023797586
Name:SONGBIRD PSYCHIATRIC AND RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:SONGBIRD PSYCHIATRIC AND RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:440-864-2802
Mailing Address - Street 1:159 CROCKER PARK BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8147
Mailing Address - Country:US
Mailing Address - Phone:440-864-2802
Mailing Address - Fax:440-287-6137
Practice Address - Street 1:159 CROCKER PARK BLVD FL 4
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-8131
Practice Address - Country:US
Practice Address - Phone:216-536-6137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0459960Medicaid