Basic Information
| Provider Information | |||||||||
| NPI: | 1346621448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELMONT BEHAVIORAL HOSPITAL, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BELMONT NORTHEAST OUTPATIENT PROGRAM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 11600 CAROLINE RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191542110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156326400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP AND SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6158616000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.