=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649741182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PB OUTPATIENT SERVICES PENNSYLVANIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2018
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1166 HILTS RD
-----------------------------------------------------
City | WRIGHTSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17368-9205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-303-9506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 POWELL CT STE 100
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-289-2169
-----------------------------------------------------
Fax | 615-261-8901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | RICHARD PRICKETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-364-1904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------