1780754465 NPI number — EAST CENTRAL MENTAL HEALTH MENTAL RETARDATION, INC

Table of content: (NPI 1780754465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780754465 NPI number — EAST CENTRAL MENTAL HEALTH MENTAL RETARDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST CENTRAL MENTAL HEALTH MENTAL RETARDATION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780754465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CHERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36081-2044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-566-6022
Provider Business Mailing Address Fax Number:
334-566-5346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CHERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36081-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-566-6022
Provider Business Practice Location Address Fax Number:
334-566-5346
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRYE
Authorized Official First Name:
MALVIA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
334-566-6022

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6342119 . This is a "UBH CAROL PLUS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51511689 . This is a "BCBS ALLKIDS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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