Provider Demographics
NPI:1548233802
Name:TWO RIVERS PSYCHIATRIC HOSPITAL INC
Entity type:Organization
Organization Name:TWO RIVERS PSYCHIATRIC HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/SR VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:1 DUNWOODY PARK STE 230
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7404
Mailing Address - Country:US
Mailing Address - Phone:678-684-5678
Mailing Address - Fax:
Practice Address - Street 1:5121 RAYTOWN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-2141
Practice Address - Country:US
Practice Address - Phone:816-356-5688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO349-19283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12569505Medicaid
MO=========OtherCHAMPUS
MO=========OtherCHAMPUS