Provider Demographics
NPI:1326213224
Name:RIVERBEND - ALL KIDS PLUS
Entity Type:Organization
Organization Name:RIVERBEND - ALL KIDS PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-768-7457
Mailing Address - Street 1:635 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5313
Mailing Address - Country:US
Mailing Address - Phone:256-768-7457
Mailing Address - Fax:256-765-2036
Practice Address - Street 1:635 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5313
Practice Address - Country:US
Practice Address - Phone:256-768-7457
Practice Address - Fax:256-765-2036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERBEND CENTER FOR MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDMH ISSUED251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-11949OtherALL KIDS PLUS