Provider Demographics
NPI:1508823956
Name:BREWER PORCH CHILDREN'S CENTER
Entity Type:Organization
Organization Name:BREWER PORCH CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-348-9340
Mailing Address - Street 1:2501 WOODLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405
Mailing Address - Country:US
Mailing Address - Phone:205-348-7236
Mailing Address - Fax:205-348-9368
Practice Address - Street 1:2501 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5028
Practice Address - Country:US
Practice Address - Phone:205-348-7236
Practice Address - Fax:205-348-9368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-28
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000027Medicaid
AL339091603Medicaid
AL330099027Medicaid
AL339091703Medicaid
ALRTF0009HMedicaid
AL8400921OtherUNITED BEHAVIORAL HEALTH
AL8400922OtherUNITED BEHAVIORAL HEALTH