Provider Demographics
NPI:1669647715
Name:CHEAHA MHC
Entity Type:Organization
Organization Name:CHEAHA MHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:256-245-1340
Mailing Address - Street 1:351 W 3RD ST
Mailing Address - Street 2:PO BOX 1248
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?:Yes
Parent Organization LBN:CHEAHA MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0515-11684OtherALLKIDS PLUS