Provider Demographics
NPI:1245294339
Name:BHC - GARDENDALE
Entity type:Organization
Organization Name:BHC - GARDENDALE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALETA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5901
Mailing Address - Street 1:758 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2696
Mailing Address - Country:US
Mailing Address - Phone:205-631-5521
Mailing Address - Fax:205-631-5540
Practice Address - Street 1:758 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2696
Practice Address - Country:US
Practice Address - Phone:205-631-5521
Practice Address - Fax:205-631-5540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-14
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529402550Medicaid
AL529402550Medicaid