Provider Demographics
NPI:1134299829
Name:EAST CENTRAL MENTAL HEALTH MENTAL RETARDATION, INC
Entity Type:Organization
Organization Name:EAST CENTRAL MENTAL HEALTH MENTAL RETARDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALVIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-566-6022
Mailing Address - Street 1:200 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-2044
Mailing Address - Country:US
Mailing Address - Phone:334-566-6022
Mailing Address - Fax:334-566-5346
Practice Address - Street 1:200 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-2044
Practice Address - Country:US
Practice Address - Phone:334-566-6022
Practice Address - Fax:334-566-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6232119OtherUBH BASIC