Provider Demographics
NPI:1073610499
Name:JEFFERSON-BLOUNT-ST. CLAIR MH/MR AUTHORITY
Entity Type:Organization
Organization Name:JEFFERSON-BLOUNT-ST. CLAIR MH/MR AUTHORITY
Other - Org Name:JBS MH/MR AUTHORITY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-595-4555
Mailing Address - Street 1:940 MONTCLAIR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1217
Mailing Address - Country:US
Mailing Address - Phone:205-595-4555
Mailing Address - Fax:205-592-3539
Practice Address - Street 1:940 MONTCLAIR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1217
Practice Address - Country:US
Practice Address - Phone:205-595-4555
Practice Address - Fax:205-592-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251B00000X, 251C00000X, 261QM0801X, 320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000017Medicaid
AL590000017Medicaid
AL51008104OtherBCBS ALL KIDS BASIC NUMBER
AL008506000Medicaid
AL330034017Medicaid