Healthcare Provider Details

I. General information

NPI: 1649741182
Provider Name (Legal Business Name): PB OUTPATIENT SERVICES PENNSYLVANIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 HILTS RD
WRIGHTSVILLE PA
17368-9205
US

IV. Provider business mailing address

103 POWELL CT STE 100
BRENTWOOD TN
37027-5050
US

V. Phone/Fax

Practice location:
  • Phone: 562-303-9506
  • Fax:
Mailing address:
  • Phone: 888-289-2169
  • Fax: 615-261-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: RICHARD PRICKETT
Title or Position: CFO
Credential:
Phone: 615-364-1904