Provider Demographics
NPI:1851566327
Name:CULLMAN ALLKIDS PLUS
Entity Type:Organization
Organization Name:CULLMAN ALLKIDS PLUS
Other - Org Name:MENTAL HEALTHCARE OF CULLMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DYKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:256-734-4688
Mailing Address - Street 1:PO BOX 2186
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-2186
Mailing Address - Country:US
Mailing Address - Phone:256-734-4688
Mailing Address - Fax:256-736-5638
Practice Address - Street 1:1909 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-6151
Practice Address - Country:US
Practice Address - Phone:256-734-4688
Practice Address - Fax:256-736-5638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CULLMAN AREA MENTAL HEALTH AUTHORITY,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1851566327OtherALL KIDS PLUS