1275687451 NPI number — CHEAHA REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD, INC.

Table of content: (NPI 1275687451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275687451 NPI number — CHEAHA REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEAHA REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD, 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:
1275687451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 W 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLACAUGA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35150-1907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-245-1340
Provider Business Mailing Address Fax Number:
256-245-1343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLACAUGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35150-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-245-1340
Provider Business Practice Location Address Fax Number:
256-245-1343
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERS
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ELECTRONIC CLAIMS ADMINISTRATOR
Authorized Official Telephone Number:
256-245-1340

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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: 515 11684 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510 08112 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510 26112 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510 79003 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510 81173 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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