Healthcare Provider Details

I. General information

NPI: 1972662625
Provider Name (Legal Business Name): BHC NORTHWEST PSYCHIATRIC HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7170 LAFAYETTE AVE
FORT WASHINGTON PA
19034
US

IV. Provider business mailing address

7170 LAFAYETTE AVE
FORT WASHINGTON PA
19034
US

V. Phone/Fax

Practice location:
  • Phone: 215-641-5300
  • Fax: 215-653-7872
Mailing address:
  • Phone: 215-641-5300
  • Fax: 215-653-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number122130
License Number StatePA

VIII. Authorized Official

Name: GLENN ALEXANDER GABRIS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 215-641-6868