1871675504 NPI number — SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC

Table of content: (NPI 1871675504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871675504 NPI number — SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871675504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2575 BOYCE PLAZA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15241-3925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-257-2290
Provider Business Mailing Address Fax Number:
412-257-7689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 OLD CONCORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPERITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15329-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-222-7486
Provider Business Practice Location Address Fax Number:
724-222-6709
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARLEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VICE PRESIDENT AND SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  402870 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 040679 . This is a "VALUE PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0130118001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007787100011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0026 . This is a "BLUE CROSS RTF" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007787100011 . This is a "CCBHO PRO RTFS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 040679A324172 . This is a "VBH PA PRO RTFS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4290243 . This is a "AETNA PRO RTFS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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