Provider Demographics
NPI:1699839183
Name:SOUTHEASTERN PSYCHIATRIC MANAGEMENT, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN PSYCHIATRIC MANAGEMENT, INC.
Other - Org Name:GRANDVIEW BEHAVIORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING NETWORK MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALLENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-546-9265
Mailing Address - Street 1:3001 SCENIC HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-3047
Mailing Address - Country:US
Mailing Address - Phone:256-546-9265
Mailing Address - Fax:256-549-0376
Practice Address - Street 1:315 ST. LUKES DRIVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7109
Practice Address - Country:US
Practice Address - Phone:334-409-9242
Practice Address - Fax:334-409-9186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI 651Medicare PIN