Provider Demographics
NPI:1750595450
Name:SOUTHWEST BEHAVIORAL CARE, INC.
Entity type:Organization
Organization Name:SOUTHWEST BEHAVIORAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:724-489-0215
Mailing Address - Street 1:203 S MAPLE AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3216
Mailing Address - Country:US
Mailing Address - Phone:724-853-7550
Mailing Address - Fax:724-853-7613
Practice Address - Street 1:1929 DAILEY AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-3087
Practice Address - Country:US
Practice Address - Phone:724-532-1700
Practice Address - Fax:724-532-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA657035261Q00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007401140150Medicaid
PA657035OtherPA STATE LICENSE