Provider Demographics
NPI:1649420704
Name:THE SYLACAUGA HEALTH CARE AUTHORITY INC
Entity Type:Organization
Organization Name:THE SYLACAUGA HEALTH CARE AUTHORITY INC
Other - Org Name:COOSA VALLEY MEDICAL CENTER SENIOR BEHAVIORAL HEALTH UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-401-4604
Mailing Address - Street 1:315 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2913
Mailing Address - Country:US
Mailing Address - Phone:256-401-4000
Mailing Address - Fax:256-401-4603
Practice Address - Street 1:315 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2913
Practice Address - Country:US
Practice Address - Phone:256-401-4000
Practice Address - Fax:256-401-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH6102273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01S164OtherMEDICARE PROVIDER NUMBER