1134187727 NPI number — CAHABA CENTER FOR MENTAL HEALTH AND MENTAL RETARDATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134187727 NPI number — CAHABA CENTER FOR MENTAL HEALTH AND MENTAL RETARDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAHABA CENTER FOR MENTAL HEALTH AND MENTAL RETARDATION
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:
1134187727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 MEDICAL CENTER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELMA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36701-7703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-875-6068
Provider Business Mailing Address Fax Number:
334-872-2084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1017 MEDICAL CENTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36701-6780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-875-2100
Provider Business Practice Location Address Fax Number:
334-418-6540
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEARDEN
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
334-875-2100

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590000021 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005437603 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008306000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330000021 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 591700014 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 591600014 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330034021 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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