Provider Demographics
NPI:1003371865
Name:ALABAMA BEHAVIORAL CARE LLC
Entity Type:Organization
Organization Name:ALABAMA BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SOLE PROPRIETOR/MEDICAL DIRECTO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:OSARETIN
Authorized Official - Last Name:OSULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-516-8699
Mailing Address - Street 1:2402 HUNTINGTON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1997
Mailing Address - Country:US
Mailing Address - Phone:205-516-8699
Mailing Address - Fax:205-238-5158
Practice Address - Street 1:1530 2ND AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1825
Practice Address - Country:US
Practice Address - Phone:205-516-8699
Practice Address - Fax:205-238-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1528226479Medicaid