Provider Demographics
NPI:1366524084
Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Entity type:Organization
Organization Name:SOUTHWOOD PSYCHIATRIC HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:MR
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 1:342 LINDEN CREEK RD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-4834
Practice Address - Country:US
Practice Address - Phone:412-257-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA404660323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040679A970656OtherVBH PA MRDD RTF
PA4290243OtherAETNA MRDD RTF
PA0026OtherBLUE CROSS RTF
PA040679OtherVALUE PROVIDER #
PA1007787100025OtherCCBHO MRDD RTF
PA1007787100025Medicaid
WV0130118001Medicaid