1114508330 NPI number — CAHABA RIVER THERAPY

Table of content: (NPI 1114508330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114508330 NPI number — CAHABA RIVER THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAHABA RIVER THERAPY
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:
1114508330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4007 MONTEVALLO RD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN BRK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35213-3030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-746-7524
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 OLD 280 CT STE 154
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VESTAVIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35243-2657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-319-1391
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRINCE
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
CLAYTON
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
205-319-1391

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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