Provider Demographics
NPI:1295829489
Name:NORTHWEST ALABAMA MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:NORTHWEST ALABAMA MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:FULTON
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW
Authorized Official - Phone:205-302-9065
Mailing Address - Street 1:1100 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-4377
Mailing Address - Country:US
Mailing Address - Phone:205-302-9000
Mailing Address - Fax:205-387-8270
Practice Address - Street 1:1100 7TH AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4377
Practice Address - Country:US
Practice Address - Phone:205-302-9000
Practice Address - Fax:205-387-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-10-17
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
AL330000015Medicaid
AL590000015Medicaid
AL330034015Medicaid
AL590000015Medicaid