Basic Information
| Provider Information | |||||||||
| NPI: | 1265754923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWOOD PSYCHIATRIC HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6100 TOWER CIR STE 1000 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370671509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158616000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 OLD CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | PROSPERITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153291422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242572290 | ||||||||
| FaxNumber: | 7248840377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2010 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP & TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 6158616000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | 422840 | PA | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
ID Information
| ID | Type | State | Issuer | Description | 0130118001 | 01 | WV | WV MEDICAL ASSISTANCE | OTHER | 100778710 | 05 | PA | MEDICAID | 7792783 | 01 | PA | AETNA BEHAVIORAL HEALTH | OTHER | 0026 | 01 | HIGHMARK BLUE CROSS BLUE SHIELD | OTHER |