Provider Demographics
NPI:1770637910
Name:EASTSIDE MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:EASTSIDE MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:205-836-7283
Mailing Address - Street 1:129 E PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3000
Mailing Address - Country:US
Mailing Address - Phone:205-836-7283
Mailing Address - Fax:205-836-9594
Practice Address - Street 1:129 E PARK CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3000
Practice Address - Country:US
Practice Address - Phone:205-836-7283
Practice Address - Fax:205-836-9594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTSIDE MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000004Medicaid
AL051008105OtherPEEHIP STATE INSURANCE
ALI023OtherMEDICARE GROUP BLOUNT
AL330000004Medicaid