Provider Demographics
NPI:1992031371
Name:SHELBY COUNTY TREATMENT CENTER
Entity Type:Organization
Organization Name:SHELBY COUNTY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STAATS-SIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF EDUCATION
Authorized Official - Phone:205-216-0200
Mailing Address - Street 1:750 HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-4627
Mailing Address - Country:US
Mailing Address - Phone:205-216-0200
Mailing Address - Fax:205-216-0203
Practice Address - Street 1:750 HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-4627
Practice Address - Country:US
Practice Address - Phone:205-216-0200
Practice Address - Fax:205-216-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health