Provider Demographics
NPI:1982375598
Name:MC MITCHELL MEMORIAL CENTER
Entity Type:Organization
Organization Name:MC MITCHELL MEMORIAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LFD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEMEKA
Authorized Official - Middle Name:LASHERRY
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-510-3950
Mailing Address - Street 1:2709 BEVERLY P WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-3449
Mailing Address - Country:US
Mailing Address - Phone:251-510-3950
Mailing Address - Fax:
Practice Address - Street 1:1302 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36610-5306
Practice Address - Country:US
Practice Address - Phone:251-510-3950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management