Provider Demographics
NPI:1275687451
Name:CHEAHA REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD, INC.
Entity Type:Organization
Organization Name:CHEAHA REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELECTRONIC CLAIMS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-245-1340
Mailing Address - Street 1:351 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-1907
Mailing Address - Country:US
Mailing Address - Phone:256-245-1340
Mailing Address - Fax:256-245-1343
Practice Address - Street 1:351 W 3RD ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-1907
Practice Address - Country:US
Practice Address - Phone:256-245-1340
Practice Address - Fax:256-245-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251B00000X, 261QM0801X, 324500000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515 11684OtherBCBS OF ALABAMA
AL510 08112OtherBCBS OF ALABAMA
AL510 26112OtherBCBS OF ALABAMA
AL510 79003OtherBCBS OF ALABAMA
AL510 81173OtherBCBS OF ALABAMA
ALG059Medicare PIN
AL510 81173OtherBCBS OF ALABAMA
AL515 11684OtherBCBS OF ALABAMA
AL102I264549Medicare PIN