Provider Demographics
NPI:1194866905
Name:SOUTH CENTRAL ALABAMA MENTAL HEALTH BOARD INC
Entity Type:Organization
Organization Name:SOUTH CENTRAL ALABAMA MENTAL HEALTH BOARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BODDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-222-2525
Mailing Address - Street 1:19815 BAY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-9234
Mailing Address - Country:US
Mailing Address - Phone:334-222-2525
Mailing Address - Fax:334-222-4660
Practice Address - Street 1:19815 BAY BRANCH RD
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-9234
Practice Address - Country:US
Practice Address - Phone:334-222-2525
Practice Address - Fax:334-222-4660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL ALABAMA MENTAL HEALTH BOARD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1530342OtherUBH BASIC
AL1530343OtherUBH PLUS
AL330034001Medicaid
AL590000001Medicaid
AL241762513OtherTRICARE
AL331600588Medicaid
AL591500029Medicaid
AL591600029Medicaid
AL9392546OtherSHAW
AL051008119OtherBLUE CROSS AND BLUE SHIEL
AL051527456OtherBLUE CROSS ANDBLUE SHIELD
AL330000001Medicaid
AL008402000Medicaid
AL331634588Medicaid
AL330000001Medicaid