Provider Demographics
NPI:1811040330
Name:SOUTHEASTERN PSYCHIATRIC MANAGEMENT, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN PSYCHIATRIC MANAGEMENT, INC.
Other - Org Name:MOUNTAIN VIEW HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING NETWORK MANAGER
Authorized Official - Prefix:
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 HWY
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 1:3001 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-3047
Practice Address - Country:US
Practice Address - Phone:256-546-9265
Practice Address - Fax:256-549-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD632Medicare PIN