1235401365 NPI number — MRS. SELENA DELOACH LLOYD RN

Table of content: MRS. SELENA DELOACH LLOYD RN (NPI 1235401365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235401365 NPI number — MRS. SELENA DELOACH LLOYD RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LLOYD
Provider First Name:
SELENA
Provider Middle Name:
DELOACH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

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:
1235401365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2411 HWY 31 SOUTH
Provider Second Line Business Mailing Address:
BALDWIN COUNTY MENTAL HEALTH CENTER, INC
Provider Business Mailing Address City Name:
BAY MINETTE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36532-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-937-9708
Provider Business Mailing Address Fax Number:
251-937-9709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2411 HWY 31 S
Provider Second Line Business Practice Location Address:
BALDWIN COUNTY MENTAL HEALTH CENTER, INC.
Provider Business Practice Location Address City Name:
BAY MINETTE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-937-9708
Provider Business Practice Location Address Fax Number:
251-937-9709
Provider Enumeration Date:
02/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  1-127623 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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