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

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 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: 251B00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; 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" .
  • Taxonomy code: 324500000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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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