1285809194 NPI number — MENTAL HEALTH BOARD OF BIBB PICKENS AND TUSCALOOSA COUNTIES

Table of content: (NPI 1285809194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285809194 NPI number — MENTAL HEALTH BOARD OF BIBB PICKENS AND TUSCALOOSA COUNTIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH BOARD OF BIBB PICKENS AND TUSCALOOSA COUNTIES
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:
INDIAN RIVERS CMHC
Provider Other Organization Name Type Code:
3
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:
1285809194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35403-2190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-562-3700
Provider Business Mailing Address Fax Number:
205-562-3769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1915 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-562-3700
Provider Business Practice Location Address Fax Number:
205-562-3769
Provider Enumeration Date:
04/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
205-562-3700

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , 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)

  • Identifier: 528700510 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051008111 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051511693 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".