Provider Demographics
NPI:1396910204
Name:CAHABA CENTER FOR MENTAL HEALTH
Entity type:Organization
Organization Name:CAHABA CENTER FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAFON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-418-6500
Mailing Address - Street 1:417 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-7703
Mailing Address - Country:US
Mailing Address - Phone:334-418-6500
Mailing Address - Fax:334-872-2084
Practice Address - Street 1:1017 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6780
Practice Address - Country:US
Practice Address - Phone:334-875-2100
Practice Address - Fax:334-418-6540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAHABA CENTER FOR MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-11682OtherBLUE CROSS BLUE SHIELD ALL KIDS PLUS