Provider Demographics
NPI:1992853352
Name:ADDICTION & MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ADDICTION & MENTAL HEALTH SERVICES, LLC
Other - Org Name:BRADFORD HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-244-8112
Mailing Address - Street 1:2101 MAGNOLIA AVE S STE 518
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2853
Mailing Address - Country:US
Mailing Address - Phone:205-251-7753
Mailing Address - Fax:205-251-7760
Practice Address - Street 1:6160 SHALLOWFORD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7213
Practice Address - Country:US
Practice Address - Phone:423-892-2939
Practice Address - Fax:423-892-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014477Medicaid