Provider Demographics
NPI:1780772285
Name:CENTRAL ALABAMA VETERANS HEALTH CARE SYSTEM
Entity type:Organization
Organization Name:CENTRAL ALABAMA VETERANS HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CHIEF , PSYCHOLOGY SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:II
Authorized Official - Credentials:PSYD
Authorized Official - Phone:334-727-0550
Mailing Address - Street 1:7344 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7506
Mailing Address - Country:US
Mailing Address - Phone:334-244-4038
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5372324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility